MEDICARE: CROSSROADS OPTOMETRIC CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0001425	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	92364	OTHER	MN	PREFERRED ONE
2	2123989	OTHER	MN	MEDICA DME
3	3C258CR	OTHER	MN	BCBS DME
4	4825	OTHER	MN	HEALTHPARTNERS
5	51154HI	OTHER	MN	BCBS-MN
6	2223987	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1164448627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS OPTOMETRIC CLINIC, INC.

Provider Business Mailing Address
First Line	:	16250 DULUTH AVE SE STE 100
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-2883
Country	:	US
Telephone Number	:	952-447-2020
Fax Number	:	952-447-2322

Provider Business Practice Location Address
First Line	:	16250 DULUTH AVE SE STE 100
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-2883
Country	:	US
Telephone Number	:	952-447-2020
Fax Number	:	952-447-2322

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	LISA ANNE DAWSON-CLAUSEN
Credential	:	OD
Telephone Number	:	952-447-2020

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	12/08/2020

Similar Medicare Providers

1003803677 — LISA ANNE DAWSON-CLAUSEN O.D.
Practice Location Address:

16250 DULUTH AVE SE STE 100
PRIOR LAKE, MN
55372-2883

Practice Phone: 952-447-2020
Practice Fax: 952-447-2322

1871716688 — DR. CHAD OLSON DDS
Practice Location Address:

16250 DULUTH AVE SE STE 200
PRIOR LAKE, MN
55372-2883

Practice Phone: 952-447-4463
Practice Fax: 952-447-4453

1003039595 — DR. NEDA FALAK
Practice Location Address:

16250 DULUTH AVE SE STE 200
PRIOR LAKE, MN
55372-2883

Practice Phone: 952-447-4463
Practice Fax:

1023433075 — KEVIN CURTIS NP
Practice Location Address:

1010 W LAKE ST
MINNEAPOLIS, MN
55408-2883

Practice Phone: 866-389-2727
Practice Fax:

1306498654 — JARRED J ENTRINGER
Practice Location Address:

2725 S 700 E APT K
SALT LAKE CITY, UT
84106-2883

Practice Phone: 605-261-8734
Practice Fax:

1104439074 — ADDIE WILLIAMS
Practice Location Address:

9219 SMITH MOUNTAIN LAKE PKWY
HUDDLESTON, VA
24104-2883

Practice Phone: 540-583-1627
Practice Fax:

Directions to “CROSSROADS OPTOMETRIC CLINIC, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.