Angela Sue Smith, O.D.
Individual provider Active NPI Optometrist · Crookston, MN
NPI 1457569378 · NPPES record last updated Oct 28, 2015
Key facts
- NPI
- 1457569378
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3074 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- 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 PC
Practice addresses (Care Compare)
216 S Main St
Crookston, MN 56716-1939
Phone (218) 281-2020
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 26 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090511000459 | MN | Practitioner - Optometry | 1456442334 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3062 | WI | MD | Chiropractor |
| 3062035 | WI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agassiz Optometry Associates PC | Optometrist | Current |
Accepting new patients |
| Crookston Eye Clinic, P.C. | Optometrist | Past | Accepting new patients |
Locations
216 S Main St
Ste 2
Crookston, MN 56716
Phone (218) 281-2020
216 S Main St
Crookston, MN 56716
Phone (218) 281-2020
201 Hillestad Ave N
Fosston, MN 56542
Phone (218) 435-1717
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3062035 | WI | |
| Optometrist | 152W00000X | 3074 | MN | Yes |
Addresses
Primary practice location
216 S Main St Ste 2
Crookston, MN 56716-1939
Mailing address
216 S Main St Ste 2
Crookston, MN 56716-1939
Phone (218) 281-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38632000 | Medicaid | WI | |
| 1457569378 | Medicaid | MN |
Other providers in Crookston, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.