Rosamond Hannah Tedesco, O.D.
Individual provider Active NPI Optometrist · Blaine, MN
NPI 1548469737 · NPPES record last updated Jul 23, 2019
Key facts
- NPI
- 1548469737
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3099 (MN)
- Practice address
- 12170 Aberdeen St NE
Blaine, MN 55449 - Phone
- (763) 757-7000
- Fax
- (763) 757-3328
- NPI assigned
- Jul 17, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of California - School of Optometry, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Blaine Eye Clinic Optometrists, P.a.
Practice addresses (Care Compare)
12170 Aberdeen St NE
Blaine, MN 55449-4716
Phone (763) 757-7000
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- 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 |
|---|---|---|---|---|
| I20080618000082 | MN | Practitioner - Optometry | 8820169949 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3099 | MN | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blaine Eye Clinic Optometrists, P.a. | Optometrist | Current |
Accepting new patients |
| Hometown Eye Care, Inc | Optometrist | Past | Accepting new patients |
| Don Sealock, O.D., P.a. | Optometrist | Past | Accepting new patients |
| Gould Enterprise, PLLC | Past |
Accepting new patients | |
| The Total Vision Institute LLC | Past | Accepting new patients |
Locations
12170 Aberdeen St NE
Minneapolis, MN 55449
Phone (763) 757-7000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3099 | MN | Yes |
Addresses
Primary practice location
12170 Aberdeen St NE
Blaine, MN 55449
Mailing address
12170 Aberdeen St NE
Blaine, MN 55449-4716
Phone (763) 757-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410002980 | Other | MN | MEDICARE |
| 535482200 | Medicaid | MN |
Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2019. 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.