Individual provider Active NPI

Jason James Stensos, OD

  • Optometrist
  • Bloomington, MN
National Provider Identifier
1205844966
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3033 Issued in MN
Practice address
9721 Lyndale Ave So
Oxboro Eye Clinic
Bloomington, MN 55420
Phone
(952) 884-8338
Fax
(952) 884-4599
NPI assigned
Aug 4, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3033 MN Primary

Addresses

Primary practice location

9721 Lyndale Ave So
Oxboro Eye Clinic
Bloomington, MN 55420

Mailing address

Pobox 207158 Clarkson Optometry Inc
Dallas, TX 75320-0001
Phone (636) 200-4393

Other identifiers 2

IdentifierTypeStateIssuer
542999600MedicaidMN
652T9STOtherMNBCBS

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
I20050819000023 MN Practitioner - Optometry 8325078322 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinity Eye Care LLCGroup PAC ID 8426460890, 2 clinicians
Gregory Clark, O.D., Inc.Group PAC ID 5799880142, 3 clinicians

Practice addresses (Care Compare)

1275 Ramsey St
Suite 700
Shakopee, MN 55379-3131
Phone (952) 222-3937

5801 W 16TH St
St Louis Park, MN 55416-1446
Phone (763) 582-9612

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3033MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Infinity Eye Care LLC Optometrist CurrentSince Jul 31, 2020 Accepting new patients
Gregory Clark, O.D., Inc. Optometrist CurrentSince Sep 27, 2023 Accepting new patients
Vision World Inc Past Accepting new patients
Visionworks, Inc. Optometrist Past Accepting new patients
Vision World Inc Past Accepting new patients

Locations

12547 Riverdale Blvd NW
Coon Rapids, MN 55448
Phone (763) 712-7761

1275 Ramsey St
Ste 700
Shakopee, MN 55379
Phone (952) 222-3937

5801 W 16th St
St Louis Park, MN 55416
Phone (763) 582-9601

Interoperability endpoints

  • Direct secure messaging: jason.stensos@uprisedirect.com

Organizations & group practices 5

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": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1205844966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POBOX 207158 CLARKSON OPTOMETRY INC",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753200001",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9721 LYNDALE AVE SO",
            "address_2": "OXBORO EYE CLINIC",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "55420",
            "telephone_number": "952-884-8338",
            "fax_number": "952-884-4599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STENSOS",
        "first_name": "JASON",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2023-03-07",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "542999600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "652T9ST",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

Verify at the official NPI Registry.