James Brian Connelly, O.D.
Individual provider Active NPI Optometrist · Wahpeton, ND
NPI 1508884016 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508884016
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 481 (ND)
- Practice address
- 517 Dakota Ave
Wahpeton, ND 58075-4414 - Phone
- (701) 642-9302
- Fax
- (701) 642-4321
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 16
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Shoptikal LLC
Practice addresses (Care Compare)
1004 18TH Ave NW
Suite D
Austin, MN 55912-1993
Phone (507) 437-8228
1710 Ctr Ave W
Suite 120
Dilworth, MN 56529-1309
Phone (218) 233-1867
3051 25TH St S
Suite L
Fargo, ND 58103-6102
Phone (701) 234-0766
517 Dakota Ave
Wahpeton, ND 58075-4414
Phone (701) 642-9302
738 Kirkwood Mall
Bismarck, ND 58504-5753
Phone (701) 258-8810
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN, ND
- 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 |
|---|---|---|---|---|
| I20040401001540 | MN | Practitioner - Optometry | 2769474311 | Reassigns benefits to 1 organization |
| I20040417000448 | ND | Practitioner - Optometry | 2769474311 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 481 | ND | MD | Registered Dietitian |
| 2288 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shoptikal LLC | Optometrist | Current |
Accepting new patients |
| Shoptikal LLC | Optometrist | Current |
Accepting new patients |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Shoptikal LLC | Optometrist | Current |
Accepting new patients |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Wahpeton Family Eyecare Center, P.C. | Optometrist | Past |
Accepting new patients |
Locations
1004 18th Ave NW
Ste D
Austin, MN 55912
Phone (507) 437-8228
738 Kirkwood Mall
Bismarck, ND 58504
Phone (701) 258-8810
517 Dakota Ave
Wahpeton, ND 58075
Phone (701) 642-9302
517 Dakota Ave
#7015
Wahpeton, ND 58075
Phone (701) 642-9302
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 481 | ND | Yes |
Addresses
Primary practice location
517 Dakota Ave
Wahpeton, ND 58075-4414
Mailing address
3243 Evergreen Rd N
Fargo, ND 58102-1214
Phone (701) 298-9421
Other providers in Wahpeton, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.