ANDOVER OPTICAL INC — NPI 1972663383 (Licensed & Credentialed Technician/Technologist, Contact Lens Fitter in ANDOVER, MN)

CMS-1500 Box 24J / 33a • NPI

1972663383

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

156FC0801X

Licensed & Credentialed Technician/Technologist, Contact Lens Fitter

Box 32 Service Location & ZIP+4

13855 ROUND LAKE BLVD NW, ANDOVER, MN, 55304-3664

✓ 9-Digit EDI 837 ZIP+4 (55304-3664)

Practice Phone & Referral Fax

(763) 421-0141

Fax: (763) 421-0334

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1972663383 (ANDOVER OPTICAL INC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1972663383` (NPI-2 Organization / Facility)
Provider / Legal Name	ANDOVER OPTICAL INC
Plain-English Specialty	Licensed & Credentialed Technician/Technologist, Contact Lens Fitter NUCC Code: `156FC0801X` (Technician/Technologist, Contact Lens Fitter)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	13855 ROUND LAKE BLVD NW, ANDOVER, MN, 55304-3664
Practice Telephone / Fax	Tel: (763) 421-0141 \| Fax: (763) 421-0334
Administrative Mailing Address	13855 ROUND LAKE BLVD NW, ANDOVER, MN, 55304-3664
Enumeration & Last Sync	Enumerated: 2006-12-08 \| CMS Record Updated: 2008-02-06
Authorized Official	LAINE SANGREN (Vice Pres)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

13855 ROUND LAKE BLVD NW, ANDOVER, MN, 55304-3664

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Plain-English Taxonomy & CMS Crosswalk (156FC0801X)

What Does Taxonomy Code 156FC0801X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 156FC0801X translates to:
"Licensed & Credentialed Technician/Technologist, Contact Lens Fitter"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Technician/Technologist, Contact Lens Fitter for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ANDOVER OPTICAL INC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`156FC0800X` — Technician/Technologist, Contact Lens Plain English: Licensed & Credentialed Technician/Technologist, Contact Lens	State: N/A \| License: `Verified` \| Primary: Secondary
`156FX1800X` — Technician/Technologist, Optician Plain English: Licensed & Credentialed Eye & Vision Service Providers — Technician — Technologist, Optician	State: N/A \| License: `Verified` \| Primary: Secondary
`156FC0801X` — Technician/Technologist, Contact Lens Fitter Plain English: Licensed & Credentialed Technician/Technologist, Contact Lens Fitter	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

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ANDOVER OPTICAL INC (NPI #1972663383)