Brainerd Eyecare Center, PA
Organization Active NPI Optometrist · Brainerd, MN
NPI 1942351002 · NPPES record last updated Jan 16, 2023
Key facts
- NPI
- 1942351002
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- 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
- Jan 16, 2007
- Organization subpart
- No
Authorized official
- Name
- Anne Archibald
- Title
- Cfo
- Phone
- (218) 839-4729
Practitioners 6
-
Joshua Hanske, O.D.
-
Michael Monda, OD
-
Corey H Tabbert, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070612000588 | MN | Part B Supplier - Clinic/Group Practice | 3870691074 |
Receives reassigned benefits from 4 practitioners Practice locations: Brainerd, MN |
| O20100930025988 | MN | DME Supplier - Physician - Optometrist |
3870691074 | Practice locations: Brainerd, MN |
National Provider Directory
Locations
506 Laurel St
Brainerd, MN 56401
Phone (218) 829-0946
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes | ||
| Optician |
156FX1800X |
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 providers in Brainerd, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.