Active NPI
Rock Edward Svennungsen, O.D.
- Optometrist
- Shelby, MT
National Provider Identifier
1487607404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 446
- Practice address
- 925 Oilfield Ave
Shelby, MT 59474-2703 - Phone
- (406) 434-2763
- Fax
- (406) 434-2904
- NPI assigned
- May 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 446 | MT | Primary |
Addresses
Primary practice location
925 Oilfield Ave
Shelby, MT 59474-2703
Mailing address
925 Oilfield Ave
Shelby, MT 59474-2703
Phone (406) 434-2763
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410035739 | Other | RAILROAD MEDICARE | |
| 0480324 | Medicaid | MT |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 446 | MT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248739200000",
"number": "1487607404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 OILFIELD AVE",
"city": "SHELBY",
"state": "MT",
"postal_code": "594742703",
"telephone_number": "406-434-2763",
"fax_number": "406-434-2904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 OILFIELD AVE",
"city": "SHELBY",
"state": "MT",
"postal_code": "594742703",
"telephone_number": "406-434-2763",
"fax_number": "406-434-2904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SVENNUNGSEN",
"first_name": "ROCK",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-19",
"last_updated": "2009-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MT",
"license": "446",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410035739",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0480324",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelby, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.