Timothy Nelson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2827 Issued in MN

Practice address

11330 Fountains Dr
Maple Grove, MN 55369

Phone

(763) 494-8063

Fax

(763) 494-8062

NPI assigned

Dec 20, 2006

Last updated

Dec 11, 2018By the provider in NPPES

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

Other identifiers 1

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

Pacific University - College of Optometry, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spectacle Shoppe IncGroup PAC ID 1153447453, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spectacle Shoppe Inc.

  • Optometrist
  • New Brighton, MN
  • NPI 1588700157
  Medicare reassignment Care Compare group NPD
• Apolade Inc

  dba Costco Optical

  • Optometrist
  • Maple Grove, MN
  • NPI 1740313824
  Medicare reassignment NPD
• Visionworks, Inc.

  dba Visionworks

  • Optometrist
  • Austin, MN
  • NPI 1881962173
  Medicare reassignment
• Spectacle Shoppe Inc.

  dba The Spectacle Shoppe Inc.

  • Optometrist
  • Minneapolis, MN
  • NPI 1386965770
  NPD
• Spectacle Shoppe Inc.

  • Optometrist
  • St Louis Park, MN
  • NPI 1568118545
  NPD
• Amj Optometric Services PSC

  dba Eye Q Vision

  • Optometrist
  • Mankato, MN
  • NPI 1659635209
  NPD (past)
• Mankato Optical Inc

  dba Eye Q Vision

  • Technician/Technologist
  • Mankato, MN
  • NPI 1346322609
  NPD (past)
• Nordin Eye Care Associates Inc

  • Optometrist
  • Coon Rapids, MN
  • NPI 1194912386
  NPD (past)
• Vision World Inc

  dba Vision World

  • Eyewear Supplier
  • Stillwater, MN
  • NPI 1740365642
  NPD (past)
• Vision World Inc

  dba Vision World

  • Eyewear Supplier
  • Fergus Falls, MN
  • NPI 1982789533
  NPD (past)

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544486400000",
    "number": "1215091616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 N 4TH ST UNIT 704",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554011950",
            "telephone_number": "612-743-1400",
            "fax_number": "763-494-8062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11330 FOUNTAINS DR",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-494-8063",
            "fax_number": "763-494-8062"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Western Ave NW",
            "address_purpose": "LOCATION",
            "city": "Faribault",
            "state": "MN",
            "postal_code": "550214510",
            "country_code": "US",
            "telephone_number": "507-334-7941",
            "fax_number": "507-334-9616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "TIMOTHY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2018-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "048717100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Anne Nelson, MD
• Kirby Mae Nelson, ARNP
• Kristen R Nelson, MD
• Matthew Nelson
• Robert Allan Nelson, PHARM D
• Michelle R Nemech
• Mirtha Nesheim, M.D.
• Michelle Neufville
• New Apple Care
• New Found Hope LLC

• Optometrist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2018; 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.