Angela Sue Smith, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3074 Issued in MN

Practice address

216 S Main St Ste 2
Crookston, MN 56716-1939

Phone

(218) 281-2020

Fax

(218) 281-5997

NPI assigned

May 21, 2007

Last updated

Oct 28, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

Pacific University - College of Optometry, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Agassiz Optometry Associates PCGroup PAC ID 6507022092, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Agassiz Optometry Associates PC

  dba Crookston Eye Clinic

  • Optometrist
  • Crookston, MN
  • NPI 1740567494
  Medicare reassignment Care Compare group NPD
• Crookston Eye Clinic, P.C.

  • Optometrist
  • Crookston, MN
  • NPI 1063550457
  NPD (past)

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445990400000",
    "number": "1457569378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 S MAIN ST STE 2",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161939",
            "telephone_number": "218-281-2020",
            "fax_number": "218-281-5997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 S MAIN ST STE 2",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161939",
            "telephone_number": "218-281-2020",
            "fax_number": "218-281-5997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ANGELA",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2015-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3062035",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Serna, LPCC
• McKenzie Paige Shelby, MS, LAT, ATC
• Jessica Nichole Shockman, LICSW
• Jeremy Sich
• Darren Glen Simmons
• Candice Jean Smith
• Kendra Smith, PHARMD
• Rosalinda Narveiz Smith
• Hayley Solheim, DC
• Minerva Arriaga Soto

• Optometrist in Crookston, MN
• Providers in Crookston, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; 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.