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RIVER LAKE CLINIC
NPI 1902932965
Optometrist in Minneapolis, MN

Active since February 26, 2007CLIA 24D2135066 · Waiver
4323 E LAKE ST, MINNEAPOLIS, MN 55406(612) 722-1003(612) 721-6336 Get Directions Write a Review

NPPES record last updated: January 30, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About River Lake Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RIVER LAKE CLINIC (NPI 1902932965) is a healthcare organization registered as an optometrist in Minneapolis, Minnesota and active in the NPI registry since February 2007. The organization holds a CLIA Waiver certificate valid through August 14, 2027 and lists Michel E. Hanen-smith, Member, as its authorized official.

NPPES Registry Identity

NPI1902932965
Entity TypeOrganization
Primary Taxonomy152W00000X
Legal Business NameRIVER LAKE CLINIC LLC
Location Address4323 E LAKE STMinneapolis, MN 55406-2307
Mailing Address4323 E Lake StMinneapolis, MN 55406-2307 · (612) 722-1003 · Fax (612) 721-6336
Phone(612) 722-1003
Fax(612) 721-6336
Organization SubpartNo
Authorized OfficialMichel E. Hanen-smithMember · (612) 722-1003
Enumeration DateFebruary 26, 2007
Last NPPES UpdateJanuary 30, 2014
✔ NPI 1902932965 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 13

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
Licenses✔ Licensed in MN · 1652✔ Licensed in MN · 3331
Definition
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.
Also ListedPsychologistTaxonomy 103T00000X · License LP2754 (MN)
Also ListedPsychologist · Adult Development & AgingTaxonomy 103TA0700X · License LP2754 (MN)
Also ListedPsychologist · Cognitive & BehavioralTaxonomy 103TB0200X · License LP2754 (MN)
Also ListedPsychologist · CounselingTaxonomy 103TC1900X · License LP2754 (MN)
Also ListedPsychologist · FamilyTaxonomy 103TF0000X · License LP2754 (MN)
Also ListedPsychologist · ForensicTaxonomy 103TF0200X · License LP2754 (MN)
Also ListedOptometrist · Corneal and Contact ManagementTaxonomy 152WC0802X · License 3331 (MN)
Also ListedOptometrist · Low Vision RehabilitationTaxonomy 152WL0500X · License 3331 (MN)
Also ListedOptometrist · PediatricsTaxonomy 152WP0200X · License 3331 (MN)
Also ListedOptometrist · Sports VisionTaxonomy 152WS0006X · License 3331 (MN)
Also ListedOptometrist · Vision TherapyTaxonomy 152WV0400X · License 1652 (MN)
Also ListedOptometrist · Occupational VisionTaxonomy 152WX0102X · License 1652 (MN)
4323 E LAKE ST, Minneapolis, MN 55406
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Other Names 1

Doing Business AsRiver Lake Clinic

Other Identifiers 3

Medicare PIN410003787MN
Medicare UPINR48949MN
Medicare UPINT39578MN

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of Tennessee, HealthPartners, Medica.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2135066

River Lake Clinic LLC · Minneapolis, MN
Active · expires Aug 14, 2027
CLIA Number24D2135066
Laboratory TypePhysician Office
Certificate Effective DateAugust 15, 2025
Certificate Expiration DateAugust 14, 2027
Laboratory DirectorJoshua Hanen
Laboratory Phone(612) 721-6336
Laboratory LocationRiver Lake Clinic LLC4323 East Lake Steet, Minneapolis, MN 55406
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MICHEL E HANEN SMITH O.D., M..S
Optometrist
4323 E LAKE ST
MINNEAPOLIS, MN 55406
Hennepin County (612) 722-1003
DR. JOSHUA JESSIE DEWAR SMITH HANEN JD, OD, FAAO
Optometrist
4323 E LAKE ST
MINNEAPOLIS, MN 55406
Hennepin County (612) 722-1003
DR. SANDRA SUE SMITH HANEN EDD
Psychologist
4323 E LAKE ST
MINNEAPOLIS, MN 55406
Hennepin County (612) 722-1003

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 River Lake Clinic LLC's NPI number?

The NPI number for River Lake Clinic LLC is 1902932965. It was assigned to this organization in the NPPES registry on February 26, 2007. The provider is doing business as River Lake Clinic.

Where is River Lake Clinic LLC located?

River Lake Clinic LLC is located at 4323 E Lake St, Minneapolis, MN 55406. The listed phone number is (612) 722-1003.

What is River Lake Clinic LLC's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Does River Lake Clinic LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2135066) is associated with this NPI, valid through August 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does River Lake Clinic LLC accept?

Health plans from BlueCross BlueShield of Tennessee, HealthPartners and Medica list River Lake Clinic LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for River Lake Clinic LLC was last updated on January 30, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years 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.