Anthony Charles Traverse, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

LD2933000 Issued in MN

Practice address

10600 Old County Road 15
Plymouth, MN 55441-6210

Phone

(763) 545-8850

Fax

(763) 544-1257

NPI assigned

Sep 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

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, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kennedy Vision Health Center LLCGroup PAC ID 9739173659, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: anthony.traverse@direct.revolutionehr.com

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.

• Kennedy Vision Health Center, LLC

  • Optometrist
  • Plymouth, MN
  • NPI 1033203963
  Medicare reassignment Care Compare group NPD Authorized official
• Kennedy Vision Health Center, LLC

  • Optometrist
  • Otsego, MN
  • NPI 1255165932
  NPD Authorized official

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1255431961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10600 OLD COUNTY ROAD 15",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554416210",
            "telephone_number": "763-545-8850",
            "fax_number": "763-544-1257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10600 OLD COUNTY ROAD 15",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554416210",
            "telephone_number": "763-545-8850",
            "fax_number": "763-544-1257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVERSE",
        "first_name": "ANTHONY",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "LD2933000",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MN",
            "license": "LD2933000",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "MN",
            "license": "LD2933000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2202143",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "050972800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "417R7TR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERFERRED ONE",
            "identifier": "977521040529",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Everett Toussaint
• Aspen Townsend, M.S., CCC-SLP
• Hailee Faith Traeger, PT, DPT
• Kim Hoa Tram, PHARMD
• Heather B Trangsrud, PH.D.
• Trillium Woods LLC
• Alexis Triplett, MA, LPCC
• Erik Andrew Troff Jr.
• Anna Christine Trout, LMFT
• Troy Duncan Psychological Services PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; 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.