Corey H Tabbert OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

2883 Issued in MN

Legal business name

COREY H TABBERT OD PA

Practice address

15 NE 5TH St
Grand Rapids, MN 55744-2760

Phone

(218) 327-1148

NPI assigned

Mar 12, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Corey Tabbert, ODNPI 1902874480

Title

Owner

Phone

(218) 327-1148

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Corey H Tabbert, OD

  • Optometrist
  • Wadena, MN
  • NPI 1902874480
  Medicare reassignment Care Compare group NPD Authorized official
• Richard A Perrott, O.D.

  • Optometrist
  • Grand Rapids, MN
  • NPI 1700968336
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346284800000",
    "number": "1447525316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 NE 5TH ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557442760",
            "telephone_number": "218-327-1148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 NE 5TH ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557442760",
            "telephone_number": "218-327-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COREY H TABBERT OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-12",
        "last_updated": "2012-08-30",
        "status": "A",
        "authorized_official_last_name": "TABBERT",
        "authorized_official_first_name": "COREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-327-1148",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Todd Cortese, OTR
• County of Itasca

• Optometrist in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.