Individual provider Active NPI

Donald Wayne Calvin, O.D.

  • Optometrist
  • Maplewood, MN
National Provider Identifier
1467517144
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1643 Issued in MN
Practice address
3001 White Bear Ave N
Sears BLDG
Maplewood, MN 55109-1215
Phone
(651) 770-4274
Fax
(651) 770-1862
NPI assigned
Dec 24, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1643 MN Primary

Addresses

Primary practice location

3001 White Bear Ave N
Sears BLDG
Maplewood, MN 55109-1215

Mailing address

2540 Eagle Valley Dr
Woodbury, MN 55129-4206
Phone (651) 738-2758

Other identifiers 1

IdentifierTypeStateIssuer
636023800MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Hudson Optical Optometrist Past Accepting new patients
Gould Enterprise, PLLC PastSince Apr 17, 2018 Accepting new patients
Vision World Inc Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1166918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467517144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2540 EAGLE VALLEY DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551294206",
            "telephone_number": "651-738-2758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 WHITE BEAR AVE N",
            "address_2": "SEARS BLDG",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091215",
            "telephone_number": "651-770-4274",
            "fax_number": "651-770-1862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALVIN",
        "first_name": "DONALD",
        "middle_name": "WAYNE",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "636023800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maplewood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.