Vandesteeg & Larson Optometric Clinic PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

1709 Issued in MN

Legal business name

VANDESTEEG & LARSON OPTOMETRIC CLINIC PA

Practice address

314 Main St S
Sauk Centre, MN 56378-1349

Phone

(320) 352-2774

NPI assigned

Sep 13, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Stephen Mark Larson, OD

Title

President

Phone

(320) 352-2774

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Vandesteeg & Larson Optometric Clinic, PA

  • Eyewear Supplier
  • Glenwood, MN
  • NPI 1174929160

  6800822859

  Same PAC ID
• Vandesteeg & Larson Optometric Clinic, PA

  • Optometrist
  • Long Prairie, MN
  • NPI 1669944104

  6800822859

  Same PAC ID

Other NPIs on the same Medicare enrollment 2

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

• Vandesteeg & Larson Optometric Clinic, PA

  • Eyewear Supplier
  • Glenwood, MN
  • NPI 1174929160

  O20050712000500

  Same enrollment
• Vandesteeg & Larson Optometric Clinic, PA

  • Optometrist
  • Long Prairie, MN
  • NPI 1669944104

  O20050712000500, O20100930001171

  Same enrollment

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jonathan Larson, OD

  • Optometrist
  • Willmar, MN
  • NPI 1912061458

  MN, Optometrist

  Medicare reassignment Care Compare group NPD
• Todd Donovan Olson, O.D.

  • Optometrist
  • Alexandria, MN
  • NPI 1083775084

  MN

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410998400000",
    "number": "1851496053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 MAIN ST S",
            "city": "SAUK CENTRE",
            "state": "MN",
            "postal_code": "563781349",
            "telephone_number": "320-352-2774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 MAIN ST S",
            "city": "SAUK CENTRE",
            "state": "MN",
            "postal_code": "563781349",
            "telephone_number": "320-352-2774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANDESTEEG & LARSON OPTOMETRIC CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2014-09-18",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-352-2774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156323802",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Sauk Centre, MN
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.