NPIMap

Individual provider Active NPI

Dale E Nelson, OD

  • Optometrist
  • Glencoe, MN
National Provider Identifier
1083613830
Registry record updated Nov 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1525 Issued in MN
Practice address
1234 Greeley Ave N
Glencoe, MN 55336-2103
Phone
(320) 864-6111
Fax
(320) 864-6134
NPI assigned
Jul 14, 2005
Last updated
Nov 4, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1525 MN Primary

Addresses

Primary practice location

1234 Greeley Ave N
Glencoe, MN 55336-2103

Mailing address

4690 W Arm Rd
Spring Park, MN 55384-9703
Phone (952) 471-0562

Other identifiers 7

IdentifierTypeStateIssuer
040512010OtherMETROPOLITAN HEALTH PLAN
964661001450OtherPREFERRED ONE
22-02730OtherSELECT CARE
22-16206OtherMEDICA
602523400MedicaidMN
12370NEOtherBCBS
2202730OtherMEDICA

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

LicenseStateTypeSpecialty
1525MNMDGenetic Counselor (M.S.)

Practice roles

OrganizationSpecialtyStatusNew patients
The Eye Doctors Office, PA Optometrist Past Accepting new patients
Precision Vision Inc Optometrist Past Accepting new patients
F & G Optical Inc Optometrist Past Accepting new patients
Apolade Inc Optometrist Past Accepting new patients
Excelsior Eyecare, PLLC Optometrist PastSince Aug 1, 2009 Accepting new patients
Gerry's Vision Shoppe, Inc Past Accepting new patients
The Eye Doctors Office, PA Optometrist Past Accepting new patients

Organizations & group practices 7

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": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257292800000",
    "number": "1083613830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4690 W ARM RD",
            "city": "SPRING PARK",
            "state": "MN",
            "postal_code": "553849703",
            "telephone_number": "952-471-0562",
            "fax_number": "888-770-8024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 GREELEY AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553362103",
            "telephone_number": "320-864-6111",
            "fax_number": "320-864-6134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "DALE",
        "middle_name": "E",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2009-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "METROPOLITAN HEALTH PLAN",
            "identifier": "040512010",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "964661001450",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT CARE",
            "identifier": "22-02730",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-16206",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "602523400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "12370NE",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2202730",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glencoe, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.