Active NPI
Norman Paul Reznicow, O.D.
- Optometrist
- Fridley, MN
National Provider Identifier
1538160064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1582
- Practice address
- 7362 University Ave NE
Fridley, MN 55432-3151 - Phone
- (763) 571-1800
- Fax
- (763) 571-1880
- NPI assigned
- Aug 9, 2005
- Last updated
- Dec 16, 2009
- 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 | 1582 | MN | Primary |
Addresses
Primary practice location
7362 University Ave NE
Fridley, MN 55432-3151
Mailing address
7362 University Ave NE
Fridley, MN 55432-3151
Phone (763) 571-1800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14490RE | Other | MN | BLUE CROSS |
| 021823500 | Medicaid | MN |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| JJS Optical LLC | Optometrist | Current | Accepting new patients |
| JJS Optical LLC | Optometrist | Past | Accepting new patients |
Locations
101 5th St E
Ste 281
Saint Paul, MN 55101
Phone (651) 227-6506
1605 County Road C W
Saint Paul, MN 55113
Phone (651) 631-8112
Organizations & group practices 2
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": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260921600000",
"number": "1538160064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7362 UNIVERSITY AVE NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554323151",
"telephone_number": "763-571-1800",
"fax_number": "763-571-1880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7362 UNIVERSITY AVE NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554323151",
"telephone_number": "763-571-1800",
"fax_number": "763-571-1880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REZNICOW",
"first_name": "NORMAN",
"middle_name": "PAUL",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-09",
"last_updated": "2009-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1582",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "14490RE",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "021823500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fridley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.