Individual provider Active NPI

Matthew Stein, OD

  • Optometrist
  • Maple Grove, MN
National Provider Identifier
1205501095
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3886 Issued in MN
Practice address
13195 Weaver Lake Rd
Maple Grove, MN 55369-9410
Phone
(763) 420-5112
NPI assigned
Aug 12, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3886 MN Primary

Addresses

Primary practice location

13195 Weaver Lake Rd
Maple Grove, MN 55369-9410

Mailing address

13195 Weaver Lake Rd
Maple Grove, MN 55369-9410
Phone (763) 420-5112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210826001498 ND Practitioner - Optometry 6507261708 Reassigns benefits to 1 organization
I20231205000079 MN Practitioner - Optometry 6507261708 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
International American University at Puerto Rico - School of Optometry, 2021
Medicare assignment
May accept Medicare assignment
Group practices
Brokea Inc.Group PAC ID 9537328075, 8 clinicians

Practice addresses (Care Compare)

1202 Moore Lake Dr E
Fridley, MN 55432-5170
Phone (763) 574-0075

13195 Weaver Lake Rd
Maple Grove, MN 55369-9410
Phone (763) 420-5112

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery20

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
788NDMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Optometric Eye Care Centers, P.a. Optometrist Current Accepting new patients
Lance K Bergstrom MD, PC Optometrist CurrentSince Aug 16, 2021 Accepting new patients
Brokea Inc. Optometrist CurrentSince Dec 1, 2025 Accepting new patients
Optometric Eye Care Centers, PA Optometrist CurrentSince Oct 15, 2023 Accepting new patients
Steven B Thom, MD PC PastSince Aug 15, 2021 Accepting new patients
Optometric Eye Care Centers, PA Optometrist Past Accepting new patients

Locations

13195 Weaver Lake Rd
Maple Grove, MN 55369
Phone (763) 420-5112

7884 Main St N
Maple Grove, MN 55369
Phone (763) 420-6981

1202 Moore Lake Dr E
Minneapolis, MN 55432
Phone (763) 292-4100

1965 11th Ave E
Ste 101
Saint Paul, MN 55109
Phone (651) 777-3555

2601 University Dr S
Fargo, ND 58103
Phone (701) 235-5200

Organizations & group practices 6

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": "1628726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1205501095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13195 WEAVER LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553699410",
            "telephone_number": "763-420-5112",
            "fax_number": "763-420-6957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13195 WEAVER LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553699410",
            "telephone_number": "763-420-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEIN",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-12",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.