Randy Mathew Kelly, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2917 Issued in MN

Practice address

2195 Southdale Ctr
Edina, MN 55435-7065

Phone

(952) 920-8770

NPI assigned

May 22, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

BF Eye Care, LTDGroup PAC ID 4284735770, 2 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 and National Provider Directory roles.

• BF Eye Care LTD.

  • Optometrist
  • Blaine, MN
  • NPI 1245365253
  Medicare reassignment Care Compare group
• R & R Vision, LTD.

  • Optometrist
  • Ramsey, MN
  • NPI 1700921517
  NPD
• Blaine Audiology & Hearing Center LLC

  • Audiologist
  • Blaine, MN
  • NPI 1386069425
  NPD (past)
• Ocularra Holding. Inc

  • Optometrist
  • Blaine, MN
  • NPI 1356498075
  NPD (past)

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770537896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7962 SUNWOOD DR. NW",
            "address_2": "SUITE 300",
            "city": "RAMSEY",
            "state": "MN",
            "postal_code": "55303",
            "telephone_number": "763-213-7940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2195 SOUTHDALE CTR",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554357065",
            "telephone_number": "952-920-8770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "RANDY",
        "middle_name": "MATHEW",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Renee Keller, DPT
• Jenelle Philipczyk Kelley, PA-C
• Avery May Kellin, PT, DPT
• Elizabeth M Kellogg, DMD
• Kristen Kelly-Williams, M.D.
• J Karl Kemberling, M.D., F.A.C.S.
• Desiree Marie Kempcke, M.D.
• Beth Ann Kempf, NP
• Claire Kendall, PHARMD
• Amy Kennedy, LICSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.