Blake Kvidt, OD
Individual provider Active NPI Optometrist · Litchfield, MN
NPI 1740779388 · NPPES record last updated Jun 11, 2019
Key facts
- NPI
- 1740779388
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3599 (MN)
- Practice address
- 135 N Sibley Ave
Litchfield, MN 55355-2138 - Phone
- (320) 593-3100
- NPI assigned
- May 9, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Ohio State University - College of Optometry, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cokato Eye Center, Inc
Annandale Eye Clinic Inc
Practice addresses (Care Compare)
115 Olsen Blvd NE
Suite 300
Cokato, MN 55321-4797
Phone (320) 286-5695
500 Elm St E
Annandale, MN 55302-1149
Phone (320) 274-3701
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 13 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, 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 |
|---|---|---|---|---|
| I20180731001417 | ND | Practitioner - Optometry | 9638427131 | Reassigns benefits to 1 organization |
| I20190402000242 | MN | Practitioner - Optometry | 9638427131 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3599 | MN | MD | Clinical Social Worker |
| 755 | ND | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Annandale Eye Clinic Inc | Optometrist | Current |
Accepting new patients |
| James a. Woodmansee. OD, PC | Optometrist | Current |
Accepting new patients |
| Annandale Eye Clinic Inc | Optometrist | Current |
Accepting new patients |
| Cokato Eye Center, Inc. | Optometrist | Current |
Accepting new patients |
| Regional Eye Specialists LLC | Optometrist | Past |
Accepting new patients |
Locations
115 Olsen Blvd NE
Ste 300
Cokato, MN 55321
Phone (320) 286-5695
135 N Sibley Ave
Litchfield, MN 55355
Phone (320) 593-3100
3750 32nd Ave S
Ste 109
Grand Forks, ND 58201
Phone (701) 780-8726
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 755 | ND | |
| Optometrist | 152W00000X | 3599 | MN | Yes |
Addresses
Primary practice location
135 N Sibley Ave
Litchfield, MN 55355-2138
Mailing address
135 N Sibley Ave
Litchfield, MN 55355-2138
Phone (320) 593-3100
Other providers in Litchfield, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 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.