Individual provider Active NPI

Robert McCamy, O.D.

  • Optometrist
  • Fargo, ND
National Provider Identifier
1497892335
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
422 Issued in ND
Practice address
3402 13TH Ave S Suite D
Fargo, ND 58103
Phone
(701) 234-0939
Fax
(701) 234-9442
NPI assigned
Jan 31, 2007
Sex
Male
Sole proprietor
No

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 422 ND Primary
Optometrist 152W00000X 348 MN

Addresses

Primary practice location

3402 13TH Ave S Suite D
Fargo, ND 58103

Mailing address

2402 34TH Ave S
Fargo, ND 58104-6501
Phone (701) 234-0939

Other identifiers 1

IdentifierTypeStateIssuer
14243OtherNDBS OF ND

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20050415000524 MN Practitioner - Optometry 7517904097 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

1004 18TH Ave NW
Suite D
Austin, MN 55912-1993
Phone (507) 437-8228

830 Washington Ave
Detroit Lakes, MN 56501-3014
Phone (218) 847-2127

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery23

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
422MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Shoptikal LLC Optometrist CurrentSince Sep 26, 2022 Accepting new patients
Shoptikal LLC Optometrist Current Accepting new patients
Shoptikal LLC Optometrist CurrentSince Sep 26, 2022 Accepting new patients
3-D Optical Inc Optometrist PastSince Jul 1, 1996 Accepting new patients
I C 20 20 Eau Claire Inc Optometrist Past Accepting new patients

Locations

1004 18th Ave NW
Ste D
Austin, MN 55912
Phone (507) 437-8228

830 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 847-2127

501 Highway 10 S
Saint Cloud, MN 56304
Phone (320) 253-4695

Organizations & group practices 5

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": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497892335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2402 34TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581046501",
            "telephone_number": "701-234-0939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3402 13TH AVE S SUITE D",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-234-0939",
            "fax_number": "701-234-9442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCAMY",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "422",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "348",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS OF ND",
            "identifier": "14243",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.