Active NPI
Bass Lake Family Eye Care Inc.
- Optometrist
- Maple Grove, MN
National Provider Identifier
1962762039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2168
- Legal business name
- BASS LAKE FAMILY EYE CARE INC.
- Practice address
- 12750 Bass Lake Rd
Maple Grove, MN 55369-6307 - Phone
- (763) 553-1811
- Fax
- (763) 553-0131
- NPI assigned
- May 23, 2012
- Last updated
- May 29, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Brad A Weeks, OD
- Title
- Optometrist
- Phone
- (763) 553-1811
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2168 | MN | Primary |
Addresses
Primary practice location
12750 Bass Lake Rd
Maple Grove, MN 55369-6307
Mailing address
12750 Bass Lake Rd
Maple Grove, MN 55369-6307
Phone (763) 553-1811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
12750 Bass Lake Rd
Maple Grove, MN 55369
Phone (763) 553-1811
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Optometrist
- Maple Grove, MN
- NPI 1073694873
-
- Optometrist
- Maple Grove, MN
- NPI 1386652907
-
- Optometrist
- Saint Paul, MN
- NPI 1518232149
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337731200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1369785600000",
"number": "1962762039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12750 BASS LAKE RD",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553696307",
"telephone_number": "763-553-1811",
"fax_number": "763-553-0131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12750 BASS LAKE RD",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553696307",
"telephone_number": "763-553-1811",
"fax_number": "763-553-0131"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BASS LAKE FAMILY EYE CARE INC.",
"organizational_subpart": "NO",
"enumeration_date": "2012-05-23",
"last_updated": "2013-05-29",
"status": "A",
"authorized_official_last_name": "WEEKS",
"authorized_official_first_name": "BRAD",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OPTOMETRIST",
"authorized_official_telephone_number": "763-553-1811",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MN",
"license": "2168",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; 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.