River Lake Clinic LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1652 Issued in MN

Legal business name

RIVER LAKE CLINIC LLC

Practice address

4323 E Lake St
Minneapolis, MN 55406-2307

Phone

(612) 722-1003

Fax

(612) 721-6336

NPI assigned

Feb 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michel E. Hanen-Smith, O. D., M. S.NPI 1326119223

Title

Member

Phone

(612) 722-1003

Specialties & licenses 14

Addresses

Other names 1

• River Lake Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michel E Hanen Smith, O.D., M..S

  • Optometrist
  • Minneapolis, MN
  • NPI 1326119223
  Medicare reassignment Care Compare group NPD Authorized official
• Joshua Jessie Dewar Smith Hanen, JD, OD, FAAO

  • Optometrist
  • Minneapolis, MN
  • NPI 1407293061
  Medicare reassignment Care Compare group NPD
• Sandra Sue Smith Hanen, EDD

  • Psychologist
  • Minneapolis, MN
  • NPI 1750480679
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391040000000",
    "number": "1902932965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4323 E LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062307",
            "telephone_number": "612-722-1003",
            "fax_number": "612-721-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4323 E LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062307",
            "telephone_number": "612-722-1003",
            "fax_number": "612-721-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER LAKE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2014-01-30",
        "status": "A",
        "authorized_official_last_name": "HANEN-SMITH",
        "authorized_official_first_name": "MICHEL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "612-722-1003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O. D., M. S."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP2754",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "MN",
            "license": "LP2754",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MN",
            "license": "LP2754",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP2754",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": "MN",
            "license": "LP2754",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": "MN",
            "license": "LP2754",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1652",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3331",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MN",
            "license": "3331",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "MN",
            "license": "3331",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "MN",
            "license": "3331",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": "MN",
            "license": "3331",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "MN",
            "license": "1652",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Occupational Vision",
            "state": "MN",
            "license": "1652",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Lake Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marcel Helorian Rivard III, MD
• River Bloom Autism Care LLC
• River Counseling MN LLC
• River Health LLC
• River Hills Home Health Inc.
• River Side Home Care Provider'S, Inc
• Veronica Rivera Arteaga
• Rivera Chiropractic Center
• Carlos Alberto Rivera, D.C.
• Jennifer Rivera, DNP, APRN, ACCNS-N

• Optometrist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.