RIVER LAKE CLINIC
NPI 1902932965
Optometrist in Minneapolis, MN
NPI Status: Active since February 26, 2007
Contact Information
4323 E LAKE ST
MINNEAPOLIS, MN
ZIP 55406
Phone: (612) 722-1003
Fax: (612) 721-6336
- Organization
- Optometrist
- Accepts Insurance
- CLIA Number: 24D2135066
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-14-2027
About RIVER LAKE CLINIC
This page provides the complete NPI Profile along with additional information for River Lake Clinic, a provider established in Minneapolis, Minnesota operating as a Optometrist. The healthcare provider is registered in the NPI registry with number 1902932965 assigned on February 2007. The practitioner's primary taxonomy code is 152W00000X with license number 1652 (MN). The provider is registered as an organization and their NPI record was last updated 12 years ago. River Lake Clinic operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's is doing business as River Lake Clinic. The authorized official of this NPI record is Dr. Michel E. Hanen-smith O. D., M. S. (Member)
- NPI
- 1902932965
- Provider Legal Name
- RIVER LAKE CLINIC LLC
- Other Organization Name
- RIVER LAKE CLINIC
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 4323 E LAKE ST MINNEAPOLIS, MN 55406
- Location Phone
- (612) 722-1003
- Location Fax
- (612) 721-6336
- Mailing Address
- 4323 E LAKE ST MINNEAPOLIS, MN 55406
- Mailing Phone
- (612) 722-1003
- Mailing Fax
- (612) 721-6336
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-26-2007
- Last Update Date
- 01-30-2014
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Optometrist
- Taxonomy Code
- 152W00000X
- Type
- Eye and Vision Services Providers
- License No.
- 1652
- License State
- MN
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | LP2754 (MN) |
| 2 | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | LP2754 (MN) |
| 3 | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | LP2754 (MN) |
| 4 | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | LP2754 (MN) |
| 5 | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | LP2754 (MN) |
| 6 | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | LP2754 (MN) |
| 7 | 152W00000X | Eye and Vision Services Providers | Optometrist | 3331 (MN) |
| 8 | 152WC0802X | Eye and Vision Services Providers | Optometrist | 3331 (MN) |
| 9 | 152WL0500X | Eye and Vision Services Providers | Optometrist | 3331 (MN) |
| 10 | 152WP0200X | Eye and Vision Services Providers | Optometrist | 3331 (MN) |
| 11 | 152WS0006X | Eye and Vision Services Providers | Optometrist | 3331 (MN) |
| 12 | 152WV0400X | Eye and Vision Services Providers | Optometrist | 1652 (MN) |
| 13 | 152WX0102X | Eye and Vision Services Providers | Optometrist | 1652 (MN) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health� - EPO
- BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � - EPO
- BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health� - EPO
- Atlas $1,300 Gold - PPO
- Atlas $2,000 Standard Gold - PPO
- Atlas $3,050 Plus Silver - PPO
- Atlas $3,800 HSA Silver - PPO
- Atlas $6,000 Standard Silver - PPO
- Atlas $6,800 Plus Bronze HSA - PPO
- Atlas $7,500 Standard Bronze HSA - PPO
- Atlas $8,400 HSA Bronze - PPO
- Medica Individual Choice Bronze $0 Copay PCP Visits - HMO
- Medica Individual Choice Bronze Share - HMO
- Medica Individual Choice Expanded Bronze Standard - HMO
- Medica Individual Choice Gold $0 Copay PCP Visits - HMO
- Medica Individual Choice Gold Share - HMO
- Medica Individual Choice Gold Standard - HMO
- Medica Individual Choice Silver $0 Copay PCP Visits - HMO
- Medica Individual Choice Silver Share - HMO
- Medica Individual Choice Silver Standard - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 410003787 | MEDICARE PIN (08) | MN | |
| R48949 | MEDICARE UPIN (02) | MN | |
| T39578 | MEDICARE UPIN (02) | MN |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 24D2135066
- Facility Type
- Physician Office
- Certificate Effective Date
- August 15, 2025
- Certificate Expiration Date
- August 14, 2027
- Laboratory Director
- JOSHUA HANEN
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to River Lake Clinic to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for RIVER LAKE CLINIC
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1902932965, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 65. The final step is to find the difference between that total and the next multiple of ten (70 - 65 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 65 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 3 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1902932965, enumerated as an "organization" on February 26, 2007.
The provider is located at 4323 E LAKE ST MINNEAPOLIS, MN 55406 and the phone number is (612) 722-1003.
Optometrist with taxonomy code 152W00000X.
The provider might be accepting Accepts: BlueCross BlueShield of Tennessee, HealthPartners,. Please consult your insurance carrier or call the provider to verify.
