Individual provider Active NPI

Rodney A Melgard, O.D.

  • Optometrist
  • Buffalo, MN
National Provider Identifier
1710922679
Registry record updated May 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1812 Issued in MN
Practice address
103 Center Dr
Suite 100
Buffalo, MN 55313-2957
Phone
(763) 682-1282
NPI assigned
Jun 17, 2006
Last updated
May 12, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1812 MN Primary

Addresses

Primary practice location

103 Center Dr
Suite 100
Buffalo, MN 55313-2957

Mailing address

103 Center Drive
Buffalo, MN 55313
Phone (763) 682-1282

Other identifiers 1

IdentifierTypeStateIssuer
916023000MedicaidMN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050415000580 MN Practitioner - Optometry 6709823297 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eagan Eye Clinic LLCGroup PAC ID 0345220745, 48 clinicians

Practice addresses (Care Compare)

103 Ctr Dr
Suite 100
Buffalo, MN 55313-2958
Phone (763) 682-1282

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1812MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Eagan Eye Clinic LLC Optometrist CurrentSince Mar 17, 2020 Accepting new patients
Eagan Eye Clinic LLC Optometrist CurrentSince Mar 17, 2020 Accepting new patients
James J Hess & Scott Endres Optometrist Past Accepting new patients

Locations

103 Center Dr
Ste 100
Buffalo, MN 55313
Phone (763) 682-1282

3930 Cedar Grove Pkwy
Saint Paul, MN 55122
Phone (612) 454-5661

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305158400000",
    "number": "1710922679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 CENTER DRIVE",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "55313",
            "telephone_number": "763-682-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 CENTER DR",
            "address_2": "SUITE 100",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553132957",
            "telephone_number": "763-682-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELGARD",
        "first_name": "RODNEY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-17",
        "last_updated": "2011-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "916023000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, MN

Sources for this page

Verify at the official NPI Registry.