Active NPI
Shahrokh Khoshsohbat
- Optometrist
- Roseville, MN
National Provider Identifier
1699275735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3546
- Practice address
- 2100 Snelling Ave N Ste 39
Roseville, MN 55113-6030 - Phone
- (651) 633-6300
- NPI assigned
- Feb 15, 2018
- 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 | 3546 | MN | Primary |
Addresses
Primary practice location
2100 Snelling Ave N Ste 39
Roseville, MN 55113-6030
Mailing address
2100 Snelling Ave N Ste 39
Roseville, MN 55113-6030
Phone (651) 633-6300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3546 | MN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518652800000",
"number": "1699275735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 SNELLING AVE N STE 39",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551136030",
"telephone_number": "651-633-6300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 SNELLING AVE N STE 39",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551136030",
"telephone_number": "651-633-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOSHSOHBAT",
"first_name": "SHAHROKH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-15",
"last_updated": "2018-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "3546",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.