Michelle Marie Martin, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3053 Issued in MN

Practice address

12750 Bass Lake Rd
Maple Grove, MN 55369-6307

Phone

(763) 553-1811

Fax

(763) 553-0131

NPI assigned

Aug 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Indiana University - School of Optometry, 2006

Medicare assignment

May accept Medicare assignment

Group practices

Bass Lake Family Eye Care IncGroup PAC ID 5193964542, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Bass Lake Family Eye Care Inc.

  • Optometrist
  • Maple Grove, MN
  • NPI 1962762039

  MN

  Medicare reassignment Care Compare group
• Cornerstone Vision Clinic LLC

  • Eyewear Supplier
  • Saint Michael, MN
  • NPI 1932266111
  NPD (past)
• Gould Enterprise, PLLC

  • Clinic/Center
  • Saint Paul, MN
  • NPI 1750888335
  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": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221177600000",
    "number": "1386652907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12750 BASS LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696307",
            "telephone_number": "763-553-1811",
            "fax_number": "763-553-0131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12750 BASS LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696307",
            "telephone_number": "763-553-1811",
            "fax_number": "763-553-0131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MICHELLE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2008-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maravent Health LLC
• Timothy Blake Markson
• Lynn Marie Marrs, MSW LICSW
• Hanna Marshall, OTD, OTR/L
• Robert S Marshall, M.D.
• Raquel Martin
• Nichole Marie Martinek, LADC
• Jordan Elizabeth Martinson, PT, DPT
• Namara Masese
• Marie Katherine Maslowski, RN

• Optometrist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2008; 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.