Brandon Koupal, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3874 Issued in MN

Practice address

1004 County Road 42 E
Burnsville, MN 55337-4652

Phone

(952) 894-1400

NPI assigned

Jul 5, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Burnsville Eye Clinic LLCGroup PAC ID 4789730433, 2 clinicians

Lakeville Family Eye Care LLCGroup PAC ID 9032265871, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Burnsville Eye Clinic LLC

  • Optometrist
  • Burnsville, MN
  • NPI 1255575973
  Medicare reassignment Care Compare group NPD
• Lakeville Family Eye Care LLC

  • Optometrist
  • Lakeville, MN
  • NPI 1427292143
  Medicare reassignment Care Compare group NPD
• South Suburban Eyecare Specialists PA

  • Optometrist
  • Lakeville, MN
  • NPI 1407059678
  NPD (past)

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

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1194403774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8300 COMMONWEALTH DRIVE",
            "address_2": "APT 334",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "55344",
            "telephone_number": "605-261-6327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 COUNTY ROAD 42 E",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374652",
            "telephone_number": "952-894-1400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17690 Kenwood Trl",
            "address_purpose": "LOCATION",
            "city": "Lakeville",
            "state": "MN",
            "postal_code": "550449764",
            "country_code": "US",
            "telephone_number": "952-898-9588",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOUPAL",
        "first_name": "BRANDON",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oleksandr Komarenko
• Abdullahi Ayanle Korane
• Ruweyda Korane
• Autumn Korby
• Lindsey Kororll
• Vitaliy Pavlovich Kovdiy
• Emma Kraft, PA-S
• Gabrielle Kramer
• Olivia Jo Kramer
• Isabella Jayne Kranz

• Optometrist in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.