Dr Petronack & Associates Optometrists Inc

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

DR PETRONACK & ASSOCIATES OPTOMETRISTS INC

Practice address

7510 University Ave NE
Fridley, MN 55432-2614

Phone

(763) 784-3997

Fax

(763) 208-7958

NPI assigned

Jun 22, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Michael Petronack

Title

Owner

Phone

(763) 784-3997

Specialties & licenses 1

Addresses

Other names 1

• Fridley Optical & Eyecare Doing business as

Locations

Practitioners 2

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

• Bradley A Krider

  • Optician
  • Fridley, MN
  • NPI 1598843617
  NPD (past)
• Alicia M Yantes, O.D.

  • Optometrist
  • Andover, MN
  • NPI 1699936542
  NPD (past)

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

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571356800000",
    "number": "1932305489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7510 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322614",
            "telephone_number": "763-784-3997",
            "fax_number": "763-208-7958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7510 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322614",
            "telephone_number": "763-784-3997",
            "fax_number": "763-208-7958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR PETRONACK & ASSOCIATES OPTOMETRISTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-22",
        "last_updated": "2019-10-18",
        "status": "A",
        "authorized_official_last_name": "PETRONACK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-784-3997",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fridley Optical & Eyecare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fridley Optical & Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas J Diem, D.D.S., M.D.
• Mackenzie Laurion Diessner, M.ED, LSW, SSW
• Fadumo Dolal
• Maureen Rose Doran, RD, LD
• Dr John W Cretzmeyer Jr DDS PA
• Brianna Lynn Dreyer
• Jack H Duffy
• Christine Dumke, M.S.W. L.G.S.W.
• Brittany Marie Dusek Bertogliat, DPT
• Lisa Maria Dust, OTR

• Optician in Fridley, MN
• Providers in Fridley, MN by specialty
• Optician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; 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.