Individual provider Active NPI

Taylor Marie Wolke, OD

  • Optometrist
  • St Paul, MN
National Provider Identifier
1023502879
Registry record updated Sep 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3568 Issued in MN
Practice address
2501 Hudson Rd
#1K21
St Paul, MN 55119
Phone
(651) 737-7022
NPI assigned
Jun 15, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3568 MN Primary

Addresses

Primary practice location

2501 Hudson Rd
#1K21
St Paul, MN 55119

Mailing address

9591 Foxford Rd
Chanhassen, MN 55317-8682
Phone (651) 470-4310

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20181119000929 MN Practitioner - Optometry 6709130305 Reassigns benefits to 1 organization
I20191217001424 WI Practitioner - Optometry 6709130305

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3568MNMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
K & K Vision, Inc. Optometrist CurrentSince Dec 1, 2018 Accepting new patients

Locations

2024 Ford Pkwy
Saint Paul, MN 55116
Phone (651) 698-2020

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788825600000",
    "number": "1023502879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9591 FOXFORD RD",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553178682",
            "telephone_number": "651-470-4310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 HUDSON RD",
            "address_2": "#1K21",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55119",
            "telephone_number": "651-737-7022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLKE",
        "first_name": "TAYLOR",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-15",
        "last_updated": "2026-09-08",
        "certification_date": "2026-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Paul, MN

Sources for this page

Verify at the official NPI Registry.