Active NPI
Larry Donavon Morrison, O.D.
- Optometrist
- Mahnomen, MN
National Provider Identifier
1841298445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1739
- Practice address
- 785 S Highway 59
Mahnomen, MN 56557-5007 - Phone
- (218) 936-2020
- Fax
- (218) 935-5541
- NPI assigned
- Jul 8, 2005
- Reactivated
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1739 | MN | Primary |
Addresses
Primary practice location
785 S Highway 59
Mahnomen, MN 56557-5007
Mailing address
785 So Highway 59
P O Box 339
Mahnomen, MN 56557-5007
Phone (218) 936-2020
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0559830003 | Other | MN | DMERC |
| 0M036MO | Other | MN | NATIONAL TRIBAL CLAIMS CE |
| 553P1MO | Other | MN | BCBS |
| 051127011 | Other | MN | METROPOLITAN HEALTH PLAN |
| 0M036MO | Other | MN | ZENITH ADMIN.LOCAL 49 |
| 410036752 | Other | MN | PALMETTO GBA |
| 483361046247 | Other | MN | PREFERRED ONE |
| 906223800 | Medicaid | MN | |
| 411895571101 | Other | MN | UNICARE |
| 2229857 | Other | MN | MEDICA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1739 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lance K Bergstrom MD, PC | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219363200000",
"number": "1841298445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "785 SO HIGHWAY 59",
"address_2": "P O BOX 339",
"city": "MAHNOMEN",
"state": "MN",
"postal_code": "565575007",
"telephone_number": "218-936-2020",
"fax_number": "218-935-5541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "785 S HIGHWAY 59",
"city": "MAHNOMEN",
"state": "MN",
"postal_code": "565575007",
"telephone_number": "218-936-2020",
"fax_number": "218-935-5541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORRISON",
"first_name": "LARRY",
"middle_name": "DONAVON",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-08",
"last_updated": "2008-08-22",
"deactivation_date": "2006-03-15",
"reactivation_date": "2006-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1739",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "0559830003",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL TRIBAL CLAIMS CE",
"identifier": "0M036MO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "553P1MO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "METROPOLITAN HEALTH PLAN",
"identifier": "051127011",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ZENITH ADMIN.LOCAL 49",
"identifier": "0M036MO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA",
"identifier": "410036752",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "483361046247",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "906223800",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNICARE",
"identifier": "411895571101",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "2229857",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mahnomen, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.