Roger Lee Rengel, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1622 Issued in MN

Practice address

700 Village Center Dr
Suite 180
North Oaks, MN 55127-3019

Phone

(651) 482-1959

Fax

(651) 482-1850

NPI assigned

Jul 6, 2006

Last updated

Dec 12, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260576000000",
    "number": "1578595294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 VILLAGE CENTER DR",
            "address_2": "SUITE 180",
            "city": "NORTH OAKS",
            "state": "MN",
            "postal_code": "551273019",
            "telephone_number": "651-482-1959",
            "fax_number": "651-482-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 VILLAGE CENTER DR",
            "address_2": "SUITE 180",
            "city": "NORTH OAKS",
            "state": "MN",
            "postal_code": "551273019",
            "telephone_number": "651-482-1959",
            "fax_number": "651-482-1850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENGEL",
        "first_name": "ROGER",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2009-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "157859294",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/ BLUE SHIELD",
            "identifier": "OB800RE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "21326",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT CARE",
            "identifier": "SC1009",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "580000012",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "754723400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-02741",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "965040671001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE TAX ID",
            "identifier": "65138",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in North Oaks, MN
• Providers in North Oaks, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.