Individual provider Active NPI

Nicholas Clinton Vincelli, O.D.

  • Optometrist
  • Owatonna, MN
National Provider Identifier
1447289152
Registry record updated Sep 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3035 Issued in MN
Practice address
118 N Oak Ave
Owatonna, MN 55060-2311
Phone
(507) 451-3072
Fax
(507) 451-4291
NPI assigned
Jul 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3035 MN Primary

Addresses

Primary practice location

118 N Oak Ave
Owatonna, MN 55060-2311

Mailing address

118 N Oak Ave
Owatonna, MN 55060-2311
Phone (507) 451-3072

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
I20051012000014 MN Practitioner - Optometry 8527083260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2005
Medicare assignment
May accept Medicare assignment
Group practices
Gilthvedt Eyecare Clinic IncGroup PAC ID 6305888678, 3 clinicians

Practice addresses (Care Compare)

2560 Harvest LN
Owatonna, MN 55060-4305
Phone (507) 451-3072

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery28

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Gilthvedt Eyecare Clinic, Inc Optometrist CurrentSince Apr 7, 2009 Accepting new patients
Nicholas Vincelli Optometry, Inc. Optometrist PastSince Jul 7, 2005 Accepting new patients

Locations

118 N Oak Ave
Owatonna, MN 55060
Phone (507) 451-3072

2560 Harvest Ln
Owatonna, MN 55060
Phone (507) 451-3072

Organizations & group practices 2

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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315353600000",
    "number": "1447289152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 N OAK AVE",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550602311",
            "telephone_number": "507-451-3072",
            "fax_number": "507-451-4291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 N OAK AVE",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550602311",
            "telephone_number": "507-451-3072",
            "fax_number": "507-451-4291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINCELLI",
        "first_name": "NICHOLAS",
        "middle_name": "CLINTON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2011-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Owatonna, MN

Sources for this page

Verify at the official NPI Registry.