Active NPI
Roseau/Warroad Eye Clinic, P.a.
- Optometrist
- Roseau, MN
National Provider Identifier
1871679456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1693
- Legal business name
- ROSEAU/WARROAD EYE CLINIC, P.A.
- Practice address
- 306 N Main
Roseau, MN 56751 - Phone
- (218) 463-2020
- Fax
- (218) 463-2055
- NPI assigned
- Oct 27, 2006
- Last updated
- Aug 5, 2014
- Organization subpart
- No
NPPES NPI Registry
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.
- Title
- Owner/ Optometrist
- Phone
- (218) 463-2020
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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1618 | MN | |
| Optometrist | 152W00000X | 1693 | MN | Primary |
| Optometrist | 152W00000X | 2946 | MN |
Addresses
Primary practice location
306 N Main
Roseau, MN 56751
Mailing address
306 N Main
Roseau, MN 56751
Phone (218) 463-2020
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13962 | Other | MN | BLUE CROSS BLUE SHIELD |
| HP40537 | Other | MN | HEALTHPARTNERS |
| 13951 | Other | MN | BLUE CROSS BLUE SHIELD |
| 295457500 | Medicaid | MN | |
| 844323800 | Medicaid | MN | |
| 192K5YE | Other | MN | BLUE CROSS BLUE SHIELD |
| 275823700 | Medicaid | MN | |
| HP42709 | Other | MN | HEALTHPARTNERS |
Other names 1
- Erickson Dieter Optometrists
National Provider Directory
National Provider Directory- Tax ID family
- Devaughn Erickson Michael Dieter Partners
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Warroad, MN
- NPI 1861562340
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Optometrist
- Roseau, MN
- NPI 1790071132
-
- Optometrist
- Roseau, MN
- NPI 1811022890
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1407196800000",
"number": "1871679456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 N MAIN",
"city": "ROSEAU",
"state": "MN",
"postal_code": "56751",
"telephone_number": "218-463-2020",
"fax_number": "218-463-2055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 N MAIN",
"city": "ROSEAU",
"state": "MN",
"postal_code": "56751",
"telephone_number": "218-463-2020",
"fax_number": "218-463-2055"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROSEAU/WARROAD EYE CLINIC, P.A.",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-27",
"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": "218-463-2020",
"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": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "2946",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "13962",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP40537",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "13951",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "295457500",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "844323800",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "192K5YE",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "275823700",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP42709",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Erickson Dieter Optometrists",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Roseau, MN
- Amber Rohde
- Roseau Community School #682
- Roseau County Committee on Aging
- Roseau County Social Services
- Roseau Warroad Eye Clinic PA (Roseau Eye Clinic)
- Philip Bruce Sallberg, DDS
- Laura Saltzman, MD
- Steven Semingson, PHARMD.
- Shopko Stores Operating Co LLC (Shopko Pharmacy 744)
- Crystal Dawn Silas, MD
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.