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River Lake Clinic LLC

Optometrist in Minneapolis, MN · enumerated 2007 · authorized official Michel Hanen-Smith, Member.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1902932965

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Registry record

Entity type Organization (Type 2)
Legal business name River Lake Clinic LLC
Other name <Unavail>
Practice address 4323 E Lake St, Minneapolis, MN, 55406
Phone (612) 722-1003
Fax (612) 721-6336
Enumeration date Feb 26, 2007
Last updated in NPPES Jan 30, 2014

Taxonomy & classification

103T00000X Psychologist Behavioral Health & Social Service Providers · License LP2754 (MN) Secondary
103TA0700X Adult Development & Aging Psychologist Behavioral Health & Social Service Providers · License LP2754 (MN) Secondary
103TB0200X Cognitive & Behavioral Psychologist Behavioral Health & Social Service Providers · License LP2754 (MN) Secondary
103TC1900X Counseling Psychologist Behavioral Health & Social Service Providers · License LP2754 (MN) Secondary
103TF0000X Family Psychologist Behavioral Health & Social Service Providers · License LP2754 (MN) Secondary
103TF0200X Forensic Psychologist Behavioral Health & Social Service Providers · License LP2754 (MN) Secondary
152W00000X Optometrist Eye and Vision Services Providers · License 1652 (MN) Primary
152W00000X Optometrist Eye and Vision Services Providers · License 3331 (MN) Secondary
152WC0802X Corneal and Contact Management Optometrist Eye and Vision Services Providers · License 3331 (MN) Secondary
152WL0500X Low Vision Rehabilitation Optometrist Eye and Vision Services Providers · License 3331 (MN) Secondary
152WP0200X Pediatric Optometrist Eye and Vision Services Providers · License 3331 (MN) Secondary
152WS0006X Sports Vision Optometrist Eye and Vision Services Providers · License 3331 (MN) Secondary
152WV0400X Vision Therapy Optometrist Eye and Vision Services Providers · License 1652 (MN) Secondary
152WX0102X Occupational Vision Optometrist Eye and Vision Services Providers · License 1652 (MN) Secondary

Authorized official

Name Michel Hanen-Smith
Title Member
Phone (612) 722-1003

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

How current is this record?
Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2014-01-30. Verify at npiregistry.cms.hhs.gov.
Where is River Lake Clinic LLC located?
The practice location on file with NPPES is in Minneapolis, MN.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2014-01-30.