Organization Active NPI

Associates in Eyecare

  • Optometrist
  • Baxter, MN
National Provider Identifier
1861066920
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ASSOCIATES IN EYECARE
Practice address
14453 Edgewood Dr
Baxter, MN 56425-8459
Phone
(218) 829-1789
Fax
(218) 829-1780
NPI assigned
May 13, 2021
Last updated
May 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2021

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

Authorized official

Name
Dr. Daniel Benjamin Clayton, ODNPI 1477862555
Title
Owner/Optometrist
Phone
(701) 567-3814

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
Optometrist 152W00000X Primary

Addresses

Primary practice location

14453 Edgewood Dr
Baxter, MN 56425-8459

Mailing address

14453 Edgewood Dr
Baxter, MN 56425-8459
Phone (218) 829-1789

Other practice location 1

424 Barclay Ave
Pine River, MN 56474-1603
Phone (218) 587-2020

Other practice location 2

5457 City Hall St
Nisswa, MN 56468-2478
Phone (218) 963-2020

Other identifiers 1

IdentifierTypeStateIssuer
1124035191MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210721002104 MN Part B Supplier - Clinic/Group Practice 4082017587 Receives reassigned benefits from 3 practitioners
Practice locations: Baxter, MN
O20220706002155 MN DME Supplier - Optician 4082017587 Practice locations: Baxter, MN

National Provider Directory

National Provider Directory

Locations

14453 Edgewood Dr
Baxter, MN 56425
Phone (218) 829-1789

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": "1620864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1861066920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14453 EDGEWOOD DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258459",
            "telephone_number": "218-829-1789",
            "fax_number": "218-829-1780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14453 EDGEWOOD DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258459",
            "telephone_number": "218-829-1789",
            "fax_number": "218-829-1780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "424 Barclay Ave",
            "address_purpose": "LOCATION",
            "city": "Pine River",
            "state": "MN",
            "postal_code": "564741603",
            "country_code": "US",
            "telephone_number": "218-587-2020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5457 City Hall St",
            "address_purpose": "LOCATION",
            "city": "Nisswa",
            "state": "MN",
            "postal_code": "564682478",
            "country_code": "US",
            "telephone_number": "218-963-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ASSOCIATES IN EYECARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-13",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "CLAYTON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "701-567-3814",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124035191",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baxter, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; 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.