Provider Demographics
NPI:1366456014
Name:GROETSCH, RICKY FRANCIS (OD)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:FRANCIS
Last Name:GROETSCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MN
Mailing Address - Zip Code:56352-1485
Mailing Address - Country:US
Mailing Address - Phone:320-256-4000
Mailing Address - Fax:320-256-4002
Practice Address - Street 1:203 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MN
Practice Address - Zip Code:56352-1485
Practice Address - Country:US
Practice Address - Phone:320-256-4000
Practice Address - Fax:320-256-4002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 2082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0F373GROtherBLUE CROSS PROVIDER NUMBE
MN115186OtherUCARE PROVIDER NUMBER
MN2225597OtherMEDICA PROVIDER NUMBER
MN380225600Medicaid
MN47576OtherHEALTH PARTNERS PROVIDER
MNMN2082OtherEYEMED PROVIDER NUMBER
MN1006663OtherPREFERRED ONE PROVIDER NU
MN410031767OtherRAILROAD MEDICARE PROVIDE
MN1006663OtherPREFERRED ONE PROVIDER NU
MN2225597OtherMEDICA PROVIDER NUMBER
MNC04711Medicare PIN