NPIMap

Organization Active NPI

Roseau/Warroad Eye Clinic, P.a.

  • Optometrist
  • Warroad, MN
National Provider Identifier
1861562340
Registry record updated Aug 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
#1693 Issued in MN
Legal business name
ROSEAU/WARROAD EYE CLINIC, P.A.
Practice address
301 Lake Street NE
Warroad, MN 56763
Phone
(218) 386-2081
Fax
(218) 386-1217
NPI assigned
Nov 9, 2006
Last updated
Aug 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2014

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

Authorized official

Name
Mr. Ross James Olson, O.D.NPI 1790071132
Title
Owner/Optometrist
Phone
(218) 386-2081

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1618 MN
Optometrist 152W00000X 1693 MN
Optometrist 152W00000X 2946 MN
Optometrist 152W00000X #1693 MN Primary

Addresses

Primary practice location

301 Lake Street NE
Warroad, MN 56763

Mailing address

Box 446
301 Lake Street NE
Warroad, MN 56763
Phone (218) 386-2081

Other identifiers 3

IdentifierTypeStateIssuer
14023EROtherMNBLUE CROSS BLUE SHIELD
14000DIOtherMNBLUE CROSS BLUE SHIELD
275823700MedicaidMN

Other names 1

  • Erickson Dieter Optometrists Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Devaughn Erickson Michael Dieter Partners4 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.

Practitioners & affiliated clinicians

Practitioners 4

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": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407196800000",
    "number": "1861562340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 446",
            "address_2": "301 LAKE STREET NE",
            "city": "WARROAD",
            "state": "MN",
            "postal_code": "56763",
            "telephone_number": "218-386-2081",
            "fax_number": "218-386-1217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 LAKE STREET NE",
            "city": "WARROAD",
            "state": "MN",
            "postal_code": "56763",
            "telephone_number": "218-386-2081",
            "fax_number": "218-386-1217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSEAU/WARROAD EYE CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2014-08-05",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "218-386-2081",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1618",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1693",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2946",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "#1693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "14023ER",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "14000DI",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275823700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Erickson Dieter Optometrists",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Warroad, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; 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.