Optom Spot PC
Organization Active NPI Optometrist · South St Paul, MN
NPI 1548028699 · NPPES record last updated Mar 12, 2024
Key facts
- NPI
- 1548028699
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- OPTOM SPOT PC
- Practice address
- 903 20TH Ave N
South St Paul, MN 55075-1311 - Phone
- (612) 338-7551
- Fax
- (612) 338-7403
- NPI assigned
- Mar 12, 2024
- Organization subpart
- No
Authorized official
- Name
- Shikha Mehta, OD
- Title
- Authorized Official/OD
- Phone
- (401) 529-9964
Practitioners 1
-
Shikha Mehta, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240507003670 | MN | Part B Supplier - Clinic/Group Practice | 2466893508 |
Receives reassigned benefits from 1 practitioner Practice locations: Minneapolis, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
903 20TH Ave N
South St Paul, MN 55075-1311
Mailing address
903 20TH Ave N
South St Paul, MN 55075-1311
Phone (612) 338-7551
Other names
- Target Optical
Other providers in South St Paul, MN
- Shelly Moland
- Daniel L Monserud
- Mpowerme Behavioral Health Solutions
- Meghan Neu
- Dale Victor Olson
- Cirenia Ortega
- Keith Frank Ostrosky
- Mikke Papes
- November Paw
- Emily Pletscher
All providers in South St Paul, MN · Optometrist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.