Active NPI
Thomas J Koll, OD
- Optometrist
- Red Wing, MN
National Provider Identifier
1124123567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1928
- Practice address
- 418 West 3Rd St
Red Wing, MN 55065 - Phone
- (651) 388-0738
- Fax
- (651) 388-0739
- NPI assigned
- Sep 13, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1928 | MN | Primary |
| Optometrist | 152W00000X | 1879 | WI | |
| Optometrist | 152W00000X | 1599 | OR |
Addresses
Primary practice location
418 West 3Rd St
Red Wing, MN 55065
Mailing address
3780 Granada Plaza No
Oakdale, MN 55128
Phone (651) 779-2130
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 283R6K0 | Other | MN | BCBS |
| 2202055 | Other | MN | MEDICA |
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 |
|---|---|---|---|
| 1599 | OR | MD | Dental Hygienist |
| 1928 | MN | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Vision Centers Inc | Past | Accepting new patients | |
| Midwest Vision Centers Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Optician
- Virginia, MN
- NPI 1336352475
-
- Optician
- Red Wing, MN
- NPI 1396817953
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124123567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3780 GRANADA PLAZA NO",
"city": "OAKDALE",
"state": "MN",
"postal_code": "55128",
"telephone_number": "651-779-2130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "418 WEST 3RD ST",
"city": "RED WING",
"state": "MN",
"postal_code": "55065",
"telephone_number": "651-388-0738",
"fax_number": "651-388-0739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLL",
"first_name": "THOMAS",
"middle_name": "J",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1928",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "1879",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "1599",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "283R6K0",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "2202055",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Red Wing, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.