Individual provider Active NPI

Susan Tesch, O.D.

  • Vision Therapy Optometrist
  • Bemidji, MN
National Provider Identifier
1164525044
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vision Therapy OptometristTaxonomy code 152WV0400X
License
2148 Issued in MN
Practice address
1420 Bemidji Ave N
Bemidji, MN 56601-3814
Phone
(218) 759-1430
NPI assigned
Sep 6, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vision Therapy Optometrist 152WV0400X 2148 MN Primary

Addresses

Primary practice location

1420 Bemidji Ave N
Bemidji, MN 56601-3814

Mailing address

1420 Bemidji Ave N
Bemidji, MN 56601-3814
Phone (218) 759-1430

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050418000551 MN Practitioner - Optometry 5597703918 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kueber Eye Care PLLCGroup PAC ID 1658508668, 3 clinicians

Practice addresses (Care Compare)

110 Henrietta Ave N
Park Rapids, MN 56470-1764
Phone (218) 732-8535

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2148MNMDVision Therapy Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Kueber Eye Care PLLC Vision Therapy CurrentSince Mar 18, 2020 Accepting new patients
Mille Lacs Family Eye Care Past Accepting new patients
Bradley W Neujahr OD PA Past Accepting new patients

Locations

1011 1st St E
Park Rapids, MN 56470
Phone (218) 252-3333

1011 1st St E
Ste 1
Park Rapids, MN 56470
Phone (218) 732-8535

110 Henrietta Ave N
Park Rapids, MN 56470
Phone (218) 732-8535

Organizations & group practices 3

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": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164525044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 BEMIDJI AVE N",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013814",
            "telephone_number": "218-759-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 BEMIDJI AVE N",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013814",
            "telephone_number": "218-759-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TESCH",
        "first_name": "SUSAN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MN",
            "license": "2148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bemidji, MN

Sources for this page

Verify at the official NPI Registry.