Jesse Fenstermacher, OD
Individual provider Active NPI Optometrist · Staples, MN
NPI 1194339481 · NPPES record last updated Sep 3, 2020
Key facts
- NPI
- 1194339481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3701 (MN)
- Practice address
- 922 US 10 E
Staples, MN 56479-2371 - Phone
- (218) 894-1331
- NPI assigned
- Sep 3, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern California College of Optometry, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Staples Eye Clinic PSC
Practice addresses (Care Compare)
922 US 10
Staples, MN 56479-2371
Phone (218) 894-1331
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 22 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200929000335 | MN | Practitioner - Optometry | 6800215617 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Staples Eye Clinic PSC | Optometrist | Current |
Accepting new patients |
Locations
922 US 10 E
Staples, MN 56479
Phone 2188290946 ext. 21889
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3701 | MN | Yes |
Addresses
Primary practice location
922 US 10 E
Staples, MN 56479-2371
Mailing address
922 US 10 E
Staples, MN 56479-2371
Phone (218) 894-1331
Other providers in Staples, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.