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River Lake Clinic LLC

NPI 1902932965ActiveOrganization· Optometrist· Minneapolis, MN

Optometrist in Minneapolis, Minnesota, registered in NPPES in February 2007. The authorized official on file is Michel E. Hanen-Smith, O. D., M. S., Member. Enrolled in Medicare as part b supplier - clinic/group practice.

Overview

NPI1902932965
StatusActive
Entity typeOrganization
NPI issuedFeb 26, 2007
Last updated in NPPESJan 30, 2014

Specialties and licenses

TaxonomyCodeLicenseState
Optometrist Primary152W00000X1652MN
Psychologist103T00000XLP2754MN
Psychologist, Adult Development & Aging103TA0700XLP2754MN
Psychologist, Cognitive & Behavioral103TB0200XLP2754MN
Psychologist, Counseling103TC1900XLP2754MN
Psychologist, Family103TF0000XLP2754MN
Psychologist, Forensic103TF0200XLP2754MN
Optometrist152W00000X3331MN
Optometrist, Corneal and Contact Management152WC0802X3331MN
Optometrist, Low Vision Rehabilitation152WL0500X3331MN
Optometrist, Pediatrics152WP0200X3331MN
Optometrist, Sports Vision152WS0006X3331MN
Optometrist, Vision Therapy152WV0400X1652MN
Optometrist, Occupational Vision152WX0102X1652MN

About license numbers in NPPES

Exclusion screening

ListResultDetails
HHS-OIG LEIE · Oct 9, 2026No matchChecked by NPI and by name + state
North Carolina Medicaid · Nov 4, 2026No match—
New York OMIG · Nov 4, 2026No match—
Ohio Medicaid · Nov 4, 2026No match—
Pennsylvania Medicheck · Nov 4, 2026No match—
Washington HCA · Nov 4, 2026No match—

Official OIG search · How matching works ·Bulk check a roster

Medicare

Enrollment (PECOS)Enrolled Part B Supplier - Clinic/Group Practice (MN)

Medicare sources and data years

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