AVERA MARSHALL (NPI# 1508177890) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508177890 |
| Entity Type | Organization |
| Organization Name | AVERA MARSHALL |
| Other Organization Name | AVERA MEDICAL GROUP OPTOMETRY MOUNTAIN LAKE |
| Practice Address |
1040 3rd Ave Mountain Lake MN 56159-1587 |
| Practice Telephone | 5074272345 |
| Mailing Telephone | 5074272345 |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2010-07-01 |
| Authorized Official Name | SHARON A WILLIAMS (VP OF FINANCE/IS) |
| Authorized Official Telephone | 5075379150 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | Allopathic & Osteopathic Physicians | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 152W00000X | Optometrist | MN | Eye and Vision Services Providers |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Optometry Mountain Lake | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396229746 | Avera Marshall | Clinic/Center | 1521 Carlson St Ste 200, Marshall, MN 56258-2626 | 2018-09-21 |
| 1154856839 | Avera Marshall | Clinic/Center | 300 S Bruce St Ste D, Marshall, MN 56258-1934 | 2017-05-01 |
| 1962859058 | Avera Marshall | Dentist | 197 N Tyler St, Tyler, MN 56178-1160 | 2016-05-18 |
| 1346297041 | Avera Marshall | Home Health | 1104 E College Dr, Marshall, MN 56258-4270 | 2006-05-28 |
| 1659838290 | Avera Marshall | Occupational Therapist | 1420 E College Dr Ste 704, Marshall, MN 56258-2065 | 2019-03-01 |
| 1407330301 | Avera Marshall | Clinic/Center | 1521 Carlson St, Marshall, MN 56258-2626 | 2018-09-18 |
| 1437551785 | Avera Marshall | Clinic/Center | 300 S Bruce St, Marshall, MN 56258-1934 | 2014-09-18 |
| 1649688623 | Avera Marshall | Clinic/Center | 300 S Bruce St, Marshall, MN 56258-1934 | 2014-07-23 |
| 1710303227 | Avera Marshall | Clinic/Center | 300 S Bruce St, Marshall, MN 56258-1934 | 2014-03-07 |
| 1033535547 | Avera Marshall | In Home Supportive Care | 1104 E College Dr, Marshall, MN 56258-4270 | 2014-03-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | AVERA MARSHALL REGIONAL MEDICAL CENTER | 300 S Bruce St, Marshall, MN 56258-1934 |
| Street Address |
1040 3RD AVE |
| City | MOUNTAIN LAKE |
| State | MN |
| Zip Code | 56159-1587 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235299066 | City of Mountain Lake | Ambulance | 1100 11th Avenue, Mountain Lake, MN 56159 | 2006-12-11 |
| 1700977246 | Schneider Drug | Pharmacist | 113 East Brown, Comfrey, MN 56159 | 2006-09-28 |
| 1720432479 | Derek Swoboda | Specialist/Technologist | 710 8th St N, Mountain Lake, MN 56159-1308 | 2016-04-19 |
| 1265423990 | The Evangelical Lutheran Good Samaritan Society | Durable Medical Equipment & Medical Supplies | 745 Basinger Memorial Dr, Mountain Lake, MN 56159-1312 | 2005-11-02 |
| 1750622908 | Evangelical Lutheran Good Samaritan Society | Assisted Living Facility | 603 7th Ave, Mountain Lake, MN 56159-1333 | 2013-03-13 |
| 1568469039 | Sanford Clinic | Clinic/Center | 308 8th St N, Mountain Lake, MN 56159-1568 | 2005-06-30 |
| 1902323405 | Megan Sharon Pohlman | Physician Assistant | 308 8th St N, Mountain Lake, MN 56159-1568 | 2017-08-25 |
| 1215091145 | Sioux Valley Clinic | Clinic/Center | 308 8th St N, Mountain Lake, MN 56159-1568 | 2006-12-22 |
| 1275530750 | Steven M Harder | Family Medicine | 308 8th St N, Mountain Lake, MN 56159-1568 | 2005-06-30 |
| 1619958279 | Vernon Elliott Peterson | Pharmacist | 1007 3rd Ave, Mountain Lake, MN 56159-1587 | 2005-11-10 |
| Find all providers in zip 56159 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023615069 | Eagan Eye Clinic LLC | Optometrist | 12390 Sherburne Ave, Becker, MN 55308-9147 | 2020-10-02 |
| 1750998100 | Infinity Eye Care | Optometrist | 1275 Ramsey St Ste 700, Shakopee, MN 55379-3131 | 2020-09-29 |
| 1831700798 | Muychi Timothy Vang | Optometrist | 11217 Commerce Dr N, Champlin, MN 55316-3122 | 2020-08-13 |
| 1023628591 | Rahul Farmah | Optometrist | 680 Hwy 10 Ne, Blaine, MN 55434 | 2020-08-08 |
| 1154947455 | Lucas William Schmidt | Optometrist | 2950 Curve Crest Blvd, Stillwater, Stillwater, MN 55082 | 2020-06-23 |
| 1699399592 | Nicole Rene Schmiedt | Optometrist | 400 Selby Ave Apt 221, Saint Paul, MN 55102-4509 | 2020-06-05 |
| 1700409885 | Russell N Osnes Od & Associates Pa | Optometrist | 1340 Duckwood Dr Ste 14, Eagan, MN 55123-2324 | 2020-05-22 |
| 1225657067 | Viginia Ho | Optometrist | 680 County Road 10 Ne, Blaine, MN 55434-2329 | 2020-04-12 |
| 1992331359 | Megan Kaye Horter | Optometrist | 1 Veterans Dr # 100-77, Minneapolis, MN 55417-2309 | 2020-03-18 |
| 1639704232 | Barton Eye Care LLC | Optometrist | 2306 S Broadway St Ste 12, Alexandria, MN 56308-1883 | 2020-03-04 |
| Find all providers with the same taxonomy | ||||
| City | MOUNTAIN LAKE |
| Zip Code | 56159 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.