VANDESTEEG & LARSON OPTOMETRIC CLINIC, PA
NPI 1174929160
Eyewear Supplier in Glenwood, MN
About Vandesteeg & Larson Optometric Clinic, Pa NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
VANDESTEEG & LARSON OPTOMETRIC CLINIC, PA (NPI 1174929160), doing business as Glacial Ridge Eye Clinic, is a healthcare organization registered as an eyewear supplier in Glenwood, Minnesota and active in the NPI registry since November 2014. The organization lists Jonathan D Larson, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Vandesteeg & Larson Optometric Clinic, Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Vandesteeg & Larson Optometric Clinic, PA, which bills Medicare for the services they deliver. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Vandesteeg & Larson Optometric Clinic, PA's NPI number?
The NPI number for Vandesteeg & Larson Optometric Clinic, PA is 1174929160. It was assigned to this organization in the NPPES registry on November 18, 2014. The provider is doing business as Glacial Ridge Eye Clinic.
Where is Vandesteeg & Larson Optometric Clinic, PA located?
Vandesteeg & Larson Optometric Clinic, PA is located at 24 1st St SE, Glenwood, MN 56334. The listed phone number is (320) 634-4516.
What is Vandesteeg & Larson Optometric Clinic, PA's specialty?
The primary specialty registered for this NPI is Eyewear Supplier with taxonomy code 332H00000X.
Is Vandesteeg & Larson Optometric Clinic, PA enrolled in Medicare?
Yes. Vandesteeg & Larson Optometric Clinic, PA is registered in the Medicare PECOS enrollment system.
When is Vandesteeg & Larson Optometric Clinic, PA's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare DME enrollment for this organization (Minnesota, Physician - Optometrist) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Vandesteeg & Larson Optometric Clinic, PA?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Optometry, reassign their Medicare billing to Vandesteeg & Larson Optometric Clinic, PA. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Vandesteeg & Larson Optometric Clinic, PA was last updated on July 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Vandesteeg & Larson Optometric Clinic, Pa · NPI 1174929160
Eyewear Supplier organization in Glenwood, Minnesota. Organization record, active in the CMS NPPES registry since November 18, 2014.
## Identity
- **NPI:** 1174929160 (Entity type: Organization)
- **Enumerated:** November 18, 2014
- **Primary specialty:** Eyewear Supplier · taxonomy 332H00000X
- **Also known as:** Glacial Ridge Eye Clinic (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Jonathan Larson, OWNER
## Practice location
- **Address:** 24 1ST ST SE, Glenwood, MN 56334-1619
- **Phone:** (320) 634-4516 · **Fax:** (320) 634-4520
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (DME, Minnesota, Physician - Optometrist) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians (Optometry) reassign Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 16, 2025
- **Other identifiers:** Medicaid 10000202944 (MN); Medicaid 496063700 (MN)
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Source: [NPI Profile](https://npiprofile.com/npi/1174929160) · Data from the CMS NPPES public registry.