Active NPI
Jerome Allan Fay, O.D.
- Optometrist
- Saint Paul, MN
National Provider Identifier
1659335289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2684
- Practice address
- 1560 University Ave W
Saint Paul, MN 55104-3908 - Phone
- (651) 646-8889
- Fax
- (651) 646-3761
- NPI assigned
- Apr 12, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 2684 | MN | Primary |
Addresses
Primary practice location
1560 University Ave W
Saint Paul, MN 55104-3908
Mailing address
1600 Viewcrest Cir
Burnsville, MN 55306-5387
Phone (952) 898-0513
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2201029 | Other | MN | MEDICA |
| 140179 | Other | MN | UCARE |
| 32F04FA | Other | MN | BLUE CROSS/BLUE SHIELD |
| MEDICAL ASSISTANCE | Other | MN | MINNESOTA |
| 40288 | Other | MN | COLE MANAGED VISION |
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120201000847 | MN | Practitioner - Optometry | 0749447894 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2684 | MN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319414400000",
"number": "1659335289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 VIEWCREST CIR",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553065387",
"telephone_number": "952-898-0513",
"fax_number": "651-646-3761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1560 UNIVERSITY AVE W",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551043908",
"telephone_number": "651-646-8889",
"fax_number": "651-646-3761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAY",
"first_name": "JEROME",
"middle_name": "ALLAN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-12",
"last_updated": "2011-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "2684",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "2201029",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "140179",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "32F04FA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MINNESOTA",
"identifier": "MEDICAL ASSISTANCE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLE MANAGED VISION",
"identifier": "40288",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; 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.