Jennifer Lynn Fairbanks, O.D

Primary specialty

OptometristTaxonomy code 152W00000X

License

3334 Issued in MN

Practice address

1801 19TH Ave SW
Willmar, MN 56201

Phone

(320) 235-2020

NPI assigned

Jun 4, 2013

Sex

Female

Sole proprietor

No

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.

• Thomas N Johnson Optometric Corp

  • Optometrist
  • Sauk Rapids, MN
  • NPI 1275772790

  MN, Optometrist

  Medicare reassignment Care Compare group NPD
• Jennifer L Fairbanks Inc

  • Corneal and Contact Management Optometrist
  • Sauk Rapids, MN
  • NPI 1225951379
  NPD (past) Authorized official

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Thomas N Johnson Optometric Corp 2 clinicians

Practice addresses (Care Compare)

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 5, 2013.

{
    "created_epoch": "1370304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370390400000",
    "number": "1386081065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 19TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "56201",
            "telephone_number": "320-235-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 19TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "56201",
            "telephone_number": "320-235-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-04",
        "last_updated": "2013-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Erickson, M.S., LPCC
• Alayna Eskelson
• Wilson Antonio Esquivel
• Barry Leroy Evans, MASTER SOCIAL WORK
• Jared Jay Fairbanks, O.D.
• Faj Language Services LLC
• Jessica M Falk, DMD
• Family Surgery Center, LLC
• Family Surgery Center, LLC
• Ahmed Farah, PHARMD

• All providers in Willmar, MN
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; 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.