Individual provider Active NPI

Tamara Legg, OD

  • Optometrist
  • Edina, MN
National Provider Identifier
1275887309
Registry record updated Apr 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3309 Issued in MN
Practice address
2195 Southdale Shopping Center
Edina, MN 55435
Phone
(952) 920-8607
Fax
(952) 920-8762
NPI assigned
Oct 26, 2012
Last updated
Apr 24, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3309 MN Primary

Addresses

Primary practice location

2195 Southdale Shopping Center
Edina, MN 55435

Mailing address

2195 Southdale Shopping Center
Edina, MN 55435
Phone (952) 920-8607

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
I20190612000789 MN Practitioner - Optometry 3476886151 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2012
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3553 Hennepin Ave
Minneapolis, MN 55408-3830
Phone (612) 822-5844

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Uptown Vision Clinic, PA Optometrist CurrentSince Jun 17, 2019 Accepting new patients

Locations

3553 Hennepin Ave
Minneapolis, MN 55408
Phone (612) 822-5844

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, 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": "1351209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492992000000",
    "number": "1275887309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2195 SOUTHDALE SHOPPING CENTER",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-920-8607",
            "fax_number": "952-920-8762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2195 SOUTHDALE SHOPPING CENTER",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-920-8607",
            "fax_number": "952-920-8762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEGG",
        "first_name": "TAMARA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-26",
        "last_updated": "2017-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.