Individual provider Active NPI

Kari Lynn Eliason, O.D.

  • Optometrist
  • Forest Lake, MN
National Provider Identifier
1982735668
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
MN 2795 Issued in MN
Practice address
356 12TH St SW
Forest Lake, MN 55025-1749
Phone
(651) 464-1955
Fax
(657) 464-1977
NPI assigned
Mar 7, 2007
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X MN 2795 MN Primary

Addresses

Primary practice location

356 12TH St SW
Forest Lake, MN 55025-1749

Mailing address

124 Canal Dr
Rockford, MN 55373-9684
Phone (763) 477-5579

Other identifiers 14

IdentifierTypeStateIssuer
22-02388OtherMNMEDICA
22-02382OtherMNMEDICA
22-02383OtherMNMEDICA
910561OtherMNEYEMED
HP39679OtherMNHEALTH PARTNERS
063M5ELOtherMNBLUE CROSS BLUE SHIELD
22-02386OtherMNMEDICA
933591034648OtherMNPREFERRED ONE
137J0ELOtherMNBLUE CROSS BLUE SHIELD
141664OtherMNUCARE
22-02384OtherMNMEDICA
22-02072OtherMNMEDICA
22-02387OtherMNMEDICA
137J1ELOtherMNBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MN 2795MNMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1982735668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 CANAL DR",
            "city": "ROCKFORD",
            "state": "MN",
            "postal_code": "553739684",
            "telephone_number": "763-477-5579",
            "fax_number": "763-477-5579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "356 12TH ST SW",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550251749",
            "telephone_number": "651-464-1955",
            "fax_number": "657-464-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIASON",
        "first_name": "KARI",
        "middle_name": "LYNN",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "MN 2795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-02388",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-02382",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-02383",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "910561",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP39679",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "063M5EL",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-02386",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "933591034648",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "137J0EL",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "141664",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-02384",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-02072",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-02387",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "137J1EL",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.