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RIVER LAKE CLINIC LLC NPI 1902932965


NPI Information

NPI: 1902932965
Provider Name: RIVER LAKE CLINIC LLC

Doing Business As: RIVER LAKE CLINIC

Classification: Optometrist - 152W00000X
Entity Type: Organization

CLIA Number: 24D2135066

Address:
4323 E LAKE ST
MINNEAPOLIS, MN
ZIP 55406
Phone: (612) 722-1003
Get Directions

RIVER LAKE CLINIC LLC is an optometrist in Minneapolis, MN. The provider is 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. RIVER LAKE CLINIC LLC NPI is 1902932965. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As River Lake Clinic.

The provider's business location address is:

4323 E LAKE ST
MINNEAPOLIS, MN
ZIP 55406-307
Phone: (612) 722-1003
Fax: (612) 721-6336

The provider's authorized official is Michel E. Hanen-smith .
The authorized official title is Member and has the following contact phone number (612) 722-1003.

The CLIA number assigned to this NPI record is 24D2135066 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/26/2007 and was last updated on 1/30/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1152WX0102XOptometristOccupational Vision1652MINNESOTANo
2152WV0400XOptometristVision Therapy1652MINNESOTANo
3152W00000XOptometrist3331MINNESOTANo
4152WC0802XOptometristCorneal and Contact Management3331MINNESOTANo
5152WL0500XOptometristLow Vision Rehabilitation3331MINNESOTANo
6152WP0200XOptometristPediatrics3331MINNESOTANo
7152WS0006XOptometristSports Vision3331MINNESOTANo
8103T00000XPsychologistLP2754MINNESOTANo
9103TF0000XPsychologistFamilyLP2754MINNESOTANo
10103TC1900XPsychologistCounselingLP2754MINNESOTANo
11103TA0700XPsychologistAdult Development & AgingLP2754MINNESOTANo
12103TB0200XPsychologistCognitive & BehavioralLP2754MINNESOTANo
13103TF0200XPsychologistForensicLP2754MINNESOTANo
14152W00000XOptometrist1652MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1410003787MEDICARE PINMINNESOTA
2R48949MEDICARE UPINMINNESOTA
3T39578MEDICARE UPINMINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.