NPIMap

Organization Active NPI

Brainerd Eyecare Center, PA

  • Optician
  • Brainerd, MN
National Provider Identifier
1871856229
Registry record updated Jan 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
BRAINERD EYECARE CENTER, PA
Practice address
506 Laurel St.
Brainerd, MN 56401-3526
Phone
(218) 829-0946
Fax
(218) 829-1279
NPI assigned
Jun 20, 2012
Last updated
Jan 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2023

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

Authorized official

Name
Anne Archibald
Title
Cfo
Phone
(218) 829-0946

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X
Optician 156FX1800X Primary

Addresses

Primary practice location

506 Laurel St.
Brainerd, MN 56401-3526

Mailing address

506 Laurel St.
Brainerd, MN 56401-3526
Phone (218) 829-0946

Other identifiers 1

IdentifierTypeStateIssuer
4C345BROtherMNBLUE CROSS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673827200000",
    "number": "1871856229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 LAUREL ST.",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013526",
            "telephone_number": "218-829-0946",
            "fax_number": "218-829-1279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 LAUREL ST.",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013526",
            "telephone_number": "218-829-0946",
            "fax_number": "218-829-1279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAINERD EYECARE CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-16",
        "status": "A",
        "authorized_official_last_name": "ARCHIBALD",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-829-0946"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4C345BR",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brainerd, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2023; 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.