NPIMap

Organization Active NPI

Granite Falls Eyecare, Inc

Doing business as Ortonville Family Eyecare

  • Optometrist
  • Ortonville, MN
National Provider Identifier
1831590777
Registry record updated Sep 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2337 Issued in MN
Legal business name
GRANITE FALLS EYECARE, INC
Doing business as
Ortonville Family Eyecare
Practice address
128 2ND St NW
Ortonville, MN 56278-1409
Phone
(320) 839-3413
NPI assigned
Sep 10, 2014
Last updated
Sep 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Todd TrudelNPI 1902850852
Title
Owner
Phone
(320) 842-4131

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2337 MN Primary

Addresses

Primary practice location

128 2ND St NW
Ortonville, MN 56278-1409

Mailing address

128 2ND St NW
Ortonville, MN 56278-1409
Phone (320) 839-3413

Other names 1

  • Ortonville Family Eyecare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040804000737 MN Part B Supplier - Clinic/Group Practice 2163493081 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Benson, MN; Granite Falls, MN; Ortonville, MN

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Granite Falls Eyecare Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

28 2nd St NW
Ortonville, MN 56278
Phone (320) 839-3413

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410307200000",
    "number": "1831590777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 2ND ST NW",
            "city": "ORTONVILLE",
            "state": "MN",
            "postal_code": "562781409",
            "telephone_number": "320-839-3413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 2ND ST NW",
            "city": "ORTONVILLE",
            "state": "MN",
            "postal_code": "562781409",
            "telephone_number": "320-839-3413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE FALLS EYECARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-10",
        "last_updated": "2014-09-10",
        "status": "A",
        "authorized_official_last_name": "TRUDEL",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-842-4131"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ortonville Family Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ortonville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.