Mickelson Eye Clinic, PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

1891 Issued in MN

Legal business name

MICKELSON EYE CLINIC, PA

Practice address

126 Labree Ave S
Thief River Falls, MN 56701-2819

Phone

(218) 683-3937

Fax

(218) 683-4557

NPI assigned

Jul 13, 2006

Last updated

Apr 17, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Craig R Mickelson

Title

Owner/ Optometrist

Phone

(218) 683-3937

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

Practitioners 1

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.

• Jason Michael Schaff, O.D.

  • Optometrist
  • Grand Forks, ND
  • NPI 1124283148
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1972528776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 LABREE AVE S",
            "address_2": "PO BOX 521",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012819",
            "telephone_number": "218-683-3937",
            "fax_number": "218-683-4557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 LABREE AVE S",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012819",
            "telephone_number": "218-683-3937",
            "fax_number": "218-683-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICKELSON EYE CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "MICKELSON",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/ OPTOMETRIST",
        "authorized_official_telephone_number": "218-683-3937"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1026440",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2201140",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "71973",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "140661",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "61B37MI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Ann Manning, LICSW
• Mary McEnelly, PA C
• Denise L McSherry, DO
• Medication Management Services
• Katie Mercure, PT, DPT
• Craig Roberts Mickelson, O.D.
• Thomas Carl Mickelson, D.C.
• Midwest Vision Centers Inc (Midwest Vision Centers)
• Davis John Mills, DNP, PMHNP-BC
• Rene Helen Mooney, PSYD

• Optometrist in Thief River Falls, MN
• Providers in Thief River Falls, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; 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.