Forks Optometric, LTD.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

2122937 Issued in MN

Legal business name

FORKS OPTOMETRIC, LTD.

Practice address

107 E 2ND St
Crookston, MN 56716-1722

Phone

(218) 281-6440

Fax

(218) 281-5884

NPI assigned

Dec 9, 2011

Organization subpart

Yes

Parent organization

FORKS OPTOMETRIC, LTD.As reported in NPPES

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

Authorized official

Name

Dr. Bruce A Storhaug, O.D.NPI 1275561482

Title

Optometrist

Phone

(218) 281-6440

Specialties & licenses 1

Addresses

Other names 1

• OPTICARE Doing business as

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Forks Optometric, LTD.

  • Optometrist
  • East Grand Forks, MN
  • NPI 1144357211

  2567365794

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• Forks Optometric, LTD.

  • Optometrist
  • East Grand Forks, MN
  • NPI 1144357211

  O20040127000855

  Same enrollment

Tax ID family

Forks Optometric LTD2 organizations share this tax ID, including this one

Part of

Forks Optometric LTD

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Forks Optometric, LTD.

  • Optometrist
  • East Grand Forks, MN
  • NPI 1144357211
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Forks Optometric, LTD.

  • Optometrist
  • East Grand Forks, MN
  • NPI 1144357211
  NPPES parent name

Practitioners 3

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

• Bruce A. Storhaug, O.D.

  • Optometrist
  • East Grand Forks, MN
  • NPI 1275561482
  NPD Authorized official
• Destin Ross Coles, O.D.

  • Optometrist
  • East Grand Forks, MN
  • NPI 1275695025
  NPD
• Steven Phillip Gander, O.D.

  • Optometrist
  • East Grand Forks, MN
  • NPI 1376639476
  NPD

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

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323388800000",
    "number": "1942578562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E 2ND ST",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161722",
            "telephone_number": "218-281-6440",
            "fax_number": "218-281-5884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E 2ND ST",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161722",
            "telephone_number": "218-281-6440",
            "fax_number": "218-281-5884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORKS OPTOMETRIC, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FORKS OPTOMETRIC, LTD.",
        "enumeration_date": "2011-12-09",
        "last_updated": "2011-12-09",
        "status": "A",
        "authorized_official_last_name": "STORHAUG",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "218-281-6440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MN",
            "license": "2122937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OPTICARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lynn Marie Flateland, PCA
• Cindy Maire Flores
• Jodee Lynn Folden, PHARM.D., R.PH.
• Matthew C Forgit, O.D.
• Kendra L Forister, PHARMD
• Robert Francis French Jr.
• Shannon Lynn French
• David Fernando Frugone Larrea, M.D.
• Amelia Marie Ganyo, M.A.
• Martina Gause, LPCC, LADC

• Eyewear Supplier in Crookston, MN
• Providers in Crookston, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; 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.