Breann Marie Forliti, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3121 Issued in MN

Practice address

12170 Aberdeen St NE
Blaine, MN 55449-4716

Phone

(763) 757-7000

Fax

(763) 757-3328

NPI assigned

Jun 26, 2008

Last updated

Sep 27, 2010By the provider in NPPES

Sex

Female

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

Southern California College of Optometry, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Blaine Eye Clinic Optometrists, P.a.Group PAC ID 2264479575, 6 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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.

• North Star Vision Group, P.a.

  dba Blaine Eye Clinic

  • Durable Medical Equipment & Medical Supplies
  • Blaine, MN
  • NPI 1043363401

  Optometrist

  Medicare reassignment Care Compare group NPD Authorized official
• Cornerstone Vision Clinic LLC

  • Eyewear Supplier
  • Saint Michael, MN
  • NPI 1932266111
  NPD (past)

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285545600000",
    "number": "1265694715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 KENWOOD ST S",
            "city": "CAMBRIDGE",
            "state": "MN",
            "postal_code": "550082640",
            "telephone_number": "763-689-4397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12170 ABERDEEN ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494716",
            "telephone_number": "763-757-7000",
            "fax_number": "763-757-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORLITI",
        "first_name": "BREANN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-26",
        "last_updated": "2010-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265694715",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Joliff Fields
• Cambria Lyne Fisher
• Fitness 1St Training, Inc.
• Flavoured Home Care LLC
• Carissa Fleek
• Fountain Home Health LLC
• Fountain of Grace Home Care Inc.
• Megan Francisco, DPT
• Carol Elizabeth Franzel
• Kelly Frasier, CNP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2010; 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.