Southdale Optical Co

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SOUTHDALE OPTICAL CO

Practice address

6533 Drew Ave S
Edina, MN 55435-2103

Phone

(952) 925-9550

Fax

(952) 925-9748

NPI assigned

Nov 29, 2005

Last updated

Jun 16, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Bradley Jon Peterson

Title

President

Phone

(952) 925-9550

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Jonathan H Engman, MD

  • Ophthalmology Physician
  • Edina, MN
  • NPI 1649242918
  NPD (past)

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245110400000",
    "number": "1871576306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6533 DREW AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352103",
            "telephone_number": "952-925-9550",
            "fax_number": "952-925-9748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6533 DREW AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352103",
            "telephone_number": "952-925-9550",
            "fax_number": "952-925-9748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHDALE OPTICAL CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-29",
        "last_updated": "2009-06-16",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-925-9550",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soundgate, Inc (SoundGate Hearing Clinic)
• Maria Aglaia Soundia, DDS
• Southdale Anesthesiologists, LLC
• Southdale Dental Associates
• Southdale Internal Medicine PA
• Southdale Otolaryngology PA
• Southdale Pediatric Associates, LTD
• Southdale Periodontics
• Southdale Periodontics, PLLC
• Southdale Physicians, LLC

• Eyewear Supplier in Edina, MN
• Providers in Edina, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; 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.