Blake Kvidt, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3599 Issued in MN

Practice address

135 N Sibley Ave
Litchfield, MN 55355-2138

Phone

(320) 593-3100

NPI assigned

May 9, 2018

Last updated

Jun 11, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ND, MN2 enrollments

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 2

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, IncGroup PAC ID 8325169162, 4 clinicians

Annandale Eye Clinic IncGroup PAC ID 6800897661, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Annandale Eye Clinic Inc

  dba Annandale Eye Clinic

  • Optometrist
  • Annandale, MN
  • NPI 1629148614
  Medicare reassignment Care Compare group NPD
• Cokato Eye Center, Inc.

  • Optometrist
  • Cokato, MN
  • NPI 1245303825
  Medicare reassignment Care Compare group NPD
• James a. Woodmansee. OD, PC

  • Optometrist
  • Grand Forks, ND
  • NPI 1154590727
  Medicare reassignment NPD
• Annandale Eye Clinic Inc

  dba Litchfield Eye Center

  • Optometrist
  • Litchfield, MN
  • NPI 1992995658
  NPD
• Regional Eye Specialists LLC

  • Eyewear Supplier
  • Chaska, MN
  • NPI 1619703006

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1740779388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 N SIBLEY AVE",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "553552138",
            "telephone_number": "320-593-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 N SIBLEY AVE",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "553552138",
            "telephone_number": "320-593-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KVIDT",
        "first_name": "BLAKE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-09",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "755",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Marie Koch, RN, PHN, BSN
• Kateri Kormann
• Angela Joan Kruger, M.S. CCC-SLP
• Emily Kubesh, DPT
• Nicole Kurth, PT, DPT
• Linda Carol Larson, PHN
• Thad Peter Larson, CRNA
• Laura Laxen
• Andie Lideen
• Litchfield Chiropractic Center LLC

• Optometrist in Litchfield, MN
• Providers in Litchfield, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.