Active NPI
Stephen J Vandyke, OD
- Optometrist
- Bemidji, MN
National Provider Identifier
1003923012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1839
- Practice address
- 1611 Anne St NW
Bemidji, MN 56601-5114 - Phone
- (218) 333-2020
- Fax
- (218) 333-2019
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | 1839 | MN | |
| Optometrist | 152W00000X | 1839 | MN | Primary |
Addresses
Primary practice location
1611 Anne St NW
Bemidji, MN 56601-5114
Mailing address
1611 Anne St NW
Bemidji, MN 56601-5114
Phone (218) 333-2020
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10723 | Other | ND BCBS | |
| 016323600 | Medicaid | MN | |
| 934731 | Other | AMERICAS PPO | |
| HP17316 | Other | HEALTHPARTNERS | |
| 2219746 | Other | MEDICA | |
| 49B66VA | Other | MN BCBS | |
| 912049 | Other | PREFERREDONE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1839 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323993600000",
"number": "1003923012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1611 ANNE ST NW",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566015114",
"telephone_number": "218-333-2020",
"fax_number": "218-333-2019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1611 ANNE ST NW",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566015114",
"telephone_number": "218-333-2020",
"fax_number": "218-333-2019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDYKE",
"first_name": "STEPHEN",
"middle_name": "J",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-24",
"last_updated": "2011-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "MN",
"license": "1839",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1839",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ND BCBS",
"identifier": "10723",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "016323600",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAS PPO",
"identifier": "934731",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP17316",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "2219746",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN BCBS",
"identifier": "49B66VA",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERREDONE",
"identifier": "912049",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Bemidji, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.