Active NPI
St Peter Eyecare Center, Inc
- Optometrist
- Le Center, MN
National Provider Identifier
1972657658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2076
- Legal business name
- ST PETER EYECARE CENTER, INC
- Practice address
- 1 E Minnesota St
Le Center, MN 56057-1501 - Phone
- (507) 357-6665
- NPI assigned
- Jan 22, 2007
- Last updated
- Jun 18, 2008
- Organization subpart
- Yes
- Parent organization
- ST PETER EYECARE CENTER, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Blake Thomas Dirks, OD
- Title
- Optometrist
- Phone
- (507) 931-6436
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2076 | MN | Primary |
Addresses
Primary practice location
1 E Minnesota St
Le Center, MN 56057-1501
Mailing address
320 Sunrise Dr
Saint Peter, MN 56082-1352
Phone (507) 931-6436
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114338 | Other | MN | UCARE |
| 706140400 | Medicaid | MN | |
| 44977TH | Other | MN | BLUEPLUS EYEWEAR |
| 2200871 | Other | MN | MEDICA |
| 33077DI | Other | MN | BLUE CROSS BLUE SHIELD |
| 0322460001 | Other | MN | DMERC |
| C06707 | Other | MN | MEDICARE |
| 15568 | Other | MN | HEALTH PARTNERS |
Other names 1
- LeCenter Eyecare
National Provider Directory
National Provider Directory- Tax ID family
- Norwood Young Am Eyecre
- Part of
- Norwood Young Am Eyecre
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Saint Peter, MN
- NPI 1134274475
Locations
1 E Minnesota St
Le Center, MN 56057
Phone (507) 357-6665
Ownership & related parties
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.
-
- Optometrist
- Saint Peter, MN
- NPI 1134274475
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
- Saint Peter, MN
- NPI 1629145057
-
- Optometrist
- Saint Peter, MN
- NPI 1366640377
-
- Optometrist
- Saint Peter, MN
- NPI 1386712867
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1213747200000",
"number": "1972657658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 SUNRISE DR",
"city": "SAINT PETER",
"state": "MN",
"postal_code": "560821352",
"telephone_number": "507-931-6436",
"fax_number": "507-934-9625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 E MINNESOTA ST",
"city": "LE CENTER",
"state": "MN",
"postal_code": "560571501",
"telephone_number": "507-357-6665"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST PETER EYECARE CENTER, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ST PETER EYECARE CENTER, INC",
"enumeration_date": "2007-01-22",
"last_updated": "2008-06-18",
"status": "A",
"authorized_official_last_name": "DIRKS",
"authorized_official_first_name": "BLAKE",
"authorized_official_middle_name": "THOMAS",
"authorized_official_title_or_position": "OPTOMETRIST",
"authorized_official_telephone_number": "507-931-6436",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "2076",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "114338",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "706140400",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUEPLUS EYEWEAR",
"identifier": "44977TH",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "2200871",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "33077DI",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "0322460001",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "C06707",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "15568",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "LeCenter Eyecare",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Le Center, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.