Individual provider Active NPI

Marcie Mathes Nichols, O.D.

  • Optometrist
  • Minneapolis, MN
National Provider Identifier
1235241993
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3027 Issued in MN
Practice address
5104 Penn Ave S
Minneapolis, MN 55419-1061
Phone
(612) 270-3261
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3027 MN Primary

Addresses

Primary practice location

5104 Penn Ave S
Minneapolis, MN 55419-1061

Mailing address

5104 Penn Ave S
Minneapolis, MN 55419-1061
Phone (612) 270-3261

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
I20051005000460 MN Practitioner - Optometry 3678508991 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Perspectives Optometric Vision Clinic, PCGroup PAC ID 8426135757, 3 clinicians

Practice addresses (Care Compare)

3102 W 50TH St
Minneapolis, MN 55410-2101
Phone (612) 920-3938

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3027MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Perspectives Optometric Vision Clinic, PC Optometrist CurrentSince Jun 14, 2018 Accepting new patients

Locations

3100 W 50th St
Ste 103
Minneapolis, MN 55410
Phone (612) 270-3261

3102 W 50th St
Minneapolis, MN 55410
Phone (612) 920-3938

Organizations & group practices 1

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235241993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5104 PENN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554191061",
            "telephone_number": "612-270-3261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5104 PENN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554191061",
            "telephone_number": "612-270-3261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "MARCIE",
        "middle_name": "MATHES",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.