Active NPI
Heather Jackson, OD
- Optometrist
- Woodbury, MN
National Provider Identifier
1083266126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3641
- Practice address
- 2070 Eagle Creek LN Ste 200
Woodbury, MN 55129-3217 - Phone
- (651) 738-8040
- Fax
- (651) 714-0759
- NPI assigned
- Jul 9, 2019
- Last updated
- Oct 1, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3641 | MN | Primary |
Addresses
Primary practice location
2070 Eagle Creek LN Ste 200
Woodbury, MN 55129-3217
Mailing address
PO Box 171
Saint Michael, MN 55376-0171
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- University of Missouri St Louis - School of Optometry, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
8510 Hwy 7
St Louis Park, MN 55426-3911
Phone (952) 933-3722
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Real Eyes LLC | Current | Accepting new patients |
Locations
8510 Highway 7
St Louis Park, MN 55426
Phone (952) 933-3722
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569888000000",
"number": "1083266126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 171",
"city": "SAINT MICHAEL",
"state": "MN",
"postal_code": "553760171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2070 EAGLE CREEK LN STE 200",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551293217",
"telephone_number": "651-738-8040",
"fax_number": "651-714-0759"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "HEATHER",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-09",
"last_updated": "2019-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "3641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2019; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.