Northwest Eye Clinic, LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

360 Issued in MN

Legal business name

NORTHWEST EYE CLINIC, LLC

Practice address

250 Central Ave N Ste 107
Wayzata, MN 55391-1207

Phone

(763) 416-7600

Fax

(763) 416-7634

NPI assigned

Oct 27, 2006

Last updated

Mar 18, 2020By 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

Kelly Pettengill

Title

Credentialing and Data Management

Phone

(763) 416-7629

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Northwest Eye Clinic, LLC

  • Ophthalmology Physician
  • Maple Grove, MN
  • NPI 1164508917

  O20040204000843

  Same enrollment
• Northwest Eye Clinic, LLC

  • Ophthalmology Physician
  • St Anthony, MN
  • NPI 1255417002

  O20040204000843

  Same enrollment
• Northwest Eye Clinic, LLC

  • Ophthalmology Physician
  • Minnetonka, MN
  • NPI 1437235280

  O20040204000843

  Same enrollment
• Northwest Eye Clinic, LLC

  • Ophthalmology Physician
  • Golden Valley, MN
  • NPI 1497837306

  O20040204000843

  Same enrollment
• Northwest Eye Clinic, LLC

  • Ophthalmology Physician
  • Wayzata, MN
  • NPI 1528144375

  O20040204000843

  Same enrollment
• Northwest Eye Clinic, LLC

  • Ophthalmology Physician
  • Golden Valley, MN
  • NPI 1992044432

  O20040204000843

  Same enrollment
• Northwest Eye Clinic, P.a.

  • Ophthalmology Physician
  • Golden Valley, MN
  • NPI 1346326196

  O20040204000843

  Same enrollment

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.

• Kamran Rahmat Nejad, MD

  • Ophthalmology Physician
  • Golden Valley, MN
  • NPI 1699268292
  NPD
• Tara Jacqueline Schaab, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • Detroit, MI
  • NPI 1538586482
  NPD

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584489600000",
    "number": "1891871646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 GOLDEN VALLEY RD STE 330",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274488",
            "telephone_number": "763-416-7629",
            "fax_number": "763-383-4147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CENTRAL AVE N STE 107",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911207",
            "telephone_number": "763-416-7600",
            "fax_number": "763-416-7634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST EYE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A",
        "authorized_official_last_name": "PETTENGILL",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CREDENTIALING AND DATA MANAGEMENT",
        "authorized_official_telephone_number": "763-416-7629"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "607693900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• North Star Counseling and Trauma Specialists, PLLC
• Northland Billing Services
• Northland Dental Partners, PLLC (Shoreline Dentistry of Wayzata)
• Northwest Eye Clinic, LLC
• Northwest Eye Clinic, LLC
• Michael T Nwanna, APRN, PMHNP
• Robinah Kyallisima Nwanna, CNP, PMHNP, APRN
• Amy Lorraine Nystrom, L.AC.
• Erin O'Shaughnessy
• Gregory Vincent O'Toole, DDS

• Ophthalmology Physician in Wayzata, MN
• Providers in Wayzata, MN by specialty
• Ophthalmology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; 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.