Individual provider Active NPI

Charles Joseph Kopp, OD

  • Optometrist
  • Blaine, MN
National Provider Identifier
1366855629
Registry record updated Jun 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3384 Issued in MN
Practice address
10961 Club West Pkwy
Suite 130
Blaine, MN 55449-5866
Phone
(763) 571-7550
Fax
(763) 253-4142
NPI assigned
Jun 4, 2014
Last updated
Jun 4, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3384 MN Primary

Addresses

Primary practice location

10961 Club West Pkwy
Suite 130
Blaine, MN 55449-5866

Mailing address

11314 Davenport Cir NE
Unit D
Blaine, MN 55449-4485
Phone (651) 303-6826

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
I20140623000003 MN Practitioner - Optometry 9234353889 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minnesota Eye Consultants, PAGroup PAC ID 4284524539, 34 clinicians

Practice addresses (Care Compare)

11091 Ulysses St NE
Suite 300
Blaine, MN 55434-4238
Phone (763) 421-9410

Merit-based Incentive Payment System (MIPS)

Final score
80.11 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
60.18

Merit-based Incentive Payment System (MIPS)

Final score
91.34 of 100Reported as group
Quality
95.62
Improvement activities
40
Cost
76.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3384MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Total Eye Care LLC Optometrist CurrentSince Jun 6, 2014 Accepting new patients
Minnesota Eye Consultants, PA CurrentSince Apr 26, 2024 Accepting new patients
Total Eye Care LLC Optometrist CurrentSince Jun 6, 2014 Accepting new patients
Northwest Eye Clinic, LLC Past Accepting new patients
Minnesota Eye Laser & Surgery Centers, LLC PastSince Apr 26, 2024 Accepting new patients
Minnesota Eye Consultants, PA Past Accepting new patients

Locations

10961 Club West Pkwy
Ste 130
Blaine, MN 55449
Phone (763) 571-7550

11091 Ulysses St NE
Ste 300
Blaine, MN 55434
Phone (763) 421-9410

11725 Stinson Ave
Chisago City, MN 55013
Phone (651) 257-8421

9801 DuPont Ave S
Ste 200
Minneapolis, MN 55431

9801 DuPont Ave S
Ste 425
Minneapolis, MN 55431
Phone (952) 567-6092

12501 Whitewater Dr
Ste 310
Minnetonka, MN 55343

7125 Tamarack Rd
Ste 100
Woodbury, MN 55125

5200 Fairview Blvd
Wyoming, MN 55092
Phone (651) 464-4611

Interoperability endpoints

  • Direct secure messaging: ckopp@uvpmec.intellechartdirect.net

Organizations & group practices 6

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": "1401840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401840000000",
    "number": "1366855629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11314 DAVENPORT CIR NE",
            "address_2": "UNIT D",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494485",
            "telephone_number": "651-303-6826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10961 CLUB WEST PKWY",
            "address_2": "SUITE 130",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554495866",
            "telephone_number": "763-571-7550",
            "fax_number": "763-253-4142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPP",
        "first_name": "CHARLES",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-04",
        "last_updated": "2014-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

Verify at the official NPI Registry.