Kenneth Dodge, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2809 Issued in MN

Practice address

1850 1St Ave NE
Little Falls, MN 56345-3381

Phone

(320) 632-2391

Fax

(320) 632-2392

NPI assigned

Jan 30, 2007

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 6

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

May accept Medicare assignment

Group practices

Thomas L Nunnelee IncGroup PAC ID 4880792571, 3 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.

• Thomas L Nunnelee Inc

  dba Princeton Vision Center

  • Eyewear Supplier
  • Princeton, MN
  • NPI 1225194475
  Medicare reassignment Care Compare group NPD
• Falls Optical, Inc.

  • Optometrist
  • Little Falls, MN
  • NPI 1356563803
  Medicare reassignment NPD
• Northern Eye Center PA

  • Ophthalmology Physician
  • Brainerd, MN
  • NPI 1245399914
  Medicare reassignment NPD
• Great Northern Opticians

  • Durable Medical Equipment & Medical Supplies
  • Brainerd, MN
  • NPI 1093933483
  NPD (past)
• Thrive With Vision, PLLC

  • Vision Therapy Optometrist
  • Little Falls, MN
  • NPI 1619484078
  NPD (past)

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1346387503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22050 205TH AVE",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563455694",
            "telephone_number": "320-745-2121",
            "fax_number": "320-632-2392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 1ST AVE NE",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563453381",
            "telephone_number": "320-632-2391",
            "fax_number": "320-632-2392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODGE",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-02502",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "271L9DO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "520042300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0484240001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "169168",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "931161031064",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dahmen & Associates, Inc (Quiet Waters Counseling)
• Jill Janel Sovine Dahmen, MA, LP
• Joyce A Darisay
• Christopher David Determan, PHARM. D.
• Millie Ruth Wanous Devereaux, PA-C
• Michael J Dorle, MD
• Kristin Doucette, APRN, PMHNP
• Richard Dunning, DO
• Nicole A Ebnet, PHARMD
• David Earl Edgerton Jr., D.O.

• Optometrist in Little Falls, MN
• Providers in Little Falls, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.