Annandale Eye Clinic Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

1765 Issued in MN

Legal business name

ANNANDALE EYE CLINIC INC

Doing business as

Litchfield Eye Center

Practice address

135 N Sibley Ave
Litchfield, MN 55355-2138

Phone

(320) 593-3100

NPI assigned

Jul 30, 2007

Last updated

Jul 14, 2009By 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

Dr. Terrence Lee Tancabel, O.D.NPI 1861468670

Title

Ceo

Phone

(320) 274-3701

Specialties & licenses 1

Addresses

Other names 1

• Litchfield Eye Center Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Annandale Eye Clinic Inc

  dba Annandale Eye Clinic

  • Optometrist
  • Annandale, MN
  • NPI 1629148614

  O20070122000134

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

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.

• Terrence L Tancabel, O.D.

  • Optometrist
  • Litchfield, MN
  • NPI 1861468670
  NPD Authorized official
• Anna Claire Aho, OD

  • Optometrist
  • Annandale, MN
  • NPI 1518537786
  NPD
• Blake Kvidt, OD

  • Optometrist
  • Litchfield, MN
  • NPI 1740779388
  NPD
• Amy J Nyquist, O.D.

  • Optometrist
  • Litchfield, MN
  • NPI 1558312249
  NPD
• Katie Nicole Tancabel, O.D.

  • Optometrist
  • Annandale, MN
  • NPI 1376704940
  NPD

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247529600000",
    "number": "1992995658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 N SIBLEY AVE",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "553552138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 N SIBLEY AVE",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "553552138",
            "telephone_number": "320-593-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNANDALE EYE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2009-07-14",
        "status": "A",
        "authorized_official_last_name": "TANCABEL",
        "authorized_official_first_name": "TERRENCE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "320-274-3701",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Litchfield Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karissa L Ahlgren, CNP
• Steven Michael Bachman, DC
• Kristen Elizabeth Beikirch, MD
• Henry Michael Bernstein, MD
• Whitney Lynn Bertram-Reents, MD
• Wylie Boehmlehner, BA, LADC

• Optometrist in Litchfield, MN
• Providers in Litchfield, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.