Individual provider Active NPI

Anthony Doffin, O.D.

  • Optometrist
  • Saint Anthony, MN
National Provider Identifier
1366520538
Registry record updated Nov 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3004 Issued in MN
Practice address
2929 Pentagon Drive
Saint Anthony, MN 55418
Phone
(612) 781-4730
Fax
(763) 784-9627
NPI assigned
Nov 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3004 MN Primary

Addresses

Primary practice location

2929 Pentagon Drive
Saint Anthony, MN 55418

Mailing address

3026 Aspen Lake Dr NE
Blaine, MN 55449-7517
Phone (651) 747-7311

Other identifiers 1

IdentifierTypeStateIssuer
171652200MedicaidMN

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
I20050405000167 MN Practitioner - Optometry 1759338585 Reassigns benefits to 1 organization
Practice locations: Saint Anthony, MN

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Anthony Optometric ClinicGroup PAC ID 2163314600, 2 clinicians

Practice addresses (Care Compare)

2929 Pentagon Dr
St Anthony, MN 55418-3208
Phone (612) 781-4730

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
St Anthony Optometric Clinic CurrentSince Dec 19, 2023 Accepting new patients
Vision World Inc Past Accepting new patients
Visionworks Inc Past Accepting new patients

Locations

2929 Pentagon Dr
St Anthony, MN 55418
Phone (612) 781-4730

Organizations & group practices 3

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": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1366520538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3026 ASPEN LAKE DR NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554497517",
            "telephone_number": "651-747-7311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 PENTAGON DRIVE",
            "city": "SAINT ANTHONY",
            "state": "MN",
            "postal_code": "55418",
            "telephone_number": "612-781-4730",
            "fax_number": "763-784-9627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOFFIN",
        "first_name": "ANTHONY",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2023-11-29",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171652200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Anthony, MN

Sources for this page

Verify at the official NPI Registry.