Individual provider Active NPI

Gareth Shigemi Hataye, OD

  • Optometrist
  • Austin, MN
National Provider Identifier
1164529384
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2189 Issued in MN
Practice address
318 N Main St
Austin, MN 55912-3406
Phone
(507) 437-7768
Fax
(507) 437-7769
NPI assigned
Sep 20, 2006
Sex
Male
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
Optometrist 152W00000X 2189 MN Primary

Addresses

Primary practice location

318 N Main St
Austin, MN 55912-3406

Mailing address

318 N Main St
Austin, MN 55912-3406
Phone (507) 437-7768

Other identifiers 4

IdentifierTypeStateIssuer
1011297OtherMNPREFERRED ONE
4C069HAOtherMNBLUE CROSS BLUE SHIELD MN
115713OtherMNUCARE MINNESOTA
2200450OtherMNMEDICA

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
I20120118000302 MN Practitioner - Optometry 1658418355 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

1004 18TH Ave NW
Suite D
Austin, MN 55912-1993
Phone (507) 437-8228

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Shoptikal LLC Optometrist CurrentSince Mar 28, 2022 Accepting new patients
Shoptikal LLC Optometrist Current Accepting new patients
Shoptikal LLC Optometrist CurrentSince Mar 28, 2022 Accepting new patients

Locations

1629 Blake Ave
Albert Lea, MN 56007
Phone (507) 318-4110

1004 18th Ave NW
Ste D
Austin, MN 55912
Phone (507) 437-8228

501 Highway 10 S
Saint Cloud, MN 56304
Phone (320) 253-4695

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164529384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 N MAIN ST",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559123406",
            "telephone_number": "507-437-7768",
            "fax_number": "507-437-7769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 N MAIN ST",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559123406",
            "telephone_number": "507-437-7768",
            "fax_number": "507-437-7769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATAYE",
        "first_name": "GARETH",
        "middle_name": "SHIGEMI",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1011297",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MN",
            "identifier": "4C069HA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "115713",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2200450",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, MN

Sources for this page

Verify at the official NPI Registry.