Xuanmai Thi Ta, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

T2107 Issued in MN

Practice address

2718 Nicollet Ave
Suite No. 103
Minneapolis, MN 55408-1648

Phone

(612) 871-1518

Fax

(612) 871-2585

NPI assigned

Feb 2, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vision World Inc

  • Eyewear Supplier
  • Fergus Falls, MN
  • NPI 1982789533
  NPD (past)
• Visionworks Inc

  • Eyewear Supplier
  • Omaha, NE
  • NPI 1205924792
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205366400000",
    "number": "1003954033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12167 CARTWAY CURV",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553474254",
            "telephone_number": "612-871-1518",
            "fax_number": "612-871-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2718 NICOLLET AVE",
            "address_2": "SUITE NO. 103",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554081648",
            "telephone_number": "612-871-1518",
            "fax_number": "612-871-2585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TA",
        "first_name": "XUANMAI",
        "middle_name": "THI",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2008-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "T2107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raphael Anthony Szykowski, LICSW
• Mitchell Scott Szymczak, DO
• T S Watson DC PA
• T. McNiff, M.D., PA
• Kenny Ta
• Jill D Tabaka, RN
• Jordan Tabbakh, MD, MS
• Kathleen M Taber, M.ED., ATC
• Lesley Erin Taber, PA-C
• Alexis M Tackmann, RD

• Optometrist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.