Gregory Paul Knudsen, ABOC, NCLE

Primary specialty

OpticianTaxonomy code 156FX1800X

Practice address

1960 Twin Lakes Pkwy
Roseville, MN 55113-1324

Phone

(612) 788-1549

Fax

(651) 633-9761

NPI assigned

Feb 23, 2024

Last updated

Feb 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1708646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1851157184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 TWIN LAKES PKWY",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131324",
            "telephone_number": "612-788-1549",
            "fax_number": "651-633-9761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 TWIN LAKES PKWY",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131324",
            "telephone_number": "612-788-1549",
            "fax_number": "651-633-9761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNUDSEN",
        "first_name": "GREGORY",
        "middle_name": "PAUL",
        "credential": "ABOC, NCLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-23",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Marie Klenow, M.D.
• Amanda Marie Kleppe, MD
• Jennifer Ashley Knight, MD
• Christopher James Knoedler Jr., MD
• John P Knoedler Jr., MD
• Dennis K Kobiri, MD
• Yasemin Koksel, MD
• Joshua C Koletar, MSW, LICSW
• Ian Koltes, LADC
• Paul Yeej Kong, CMT, LMT

• Optician in Roseville, MN
• Providers in Roseville, MN by specialty
• Optician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.