Individual provider Active NPI

Kristin R. Swenson, O.D.

  • Optometrist
  • Saint Paul, MN
National Provider Identifier
1770656845
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2556 Issued in MN
Practice address
2356 University Ave W
Saint Paul, MN 55114-1853
Phone
(651) 645-8124
NPI assigned
Nov 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2556 MN Primary

Addresses

Primary practice location

2356 University Ave W
Saint Paul, MN 55114-1853

Mailing address

5924 Amy Dr
Edina, MN 55436-1934
Phone (952) 926-2476

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
I20040228000350 MN Practitioner - Optometry 0143117721 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

15670 Edgewood Dr
Suite 100
Baxter, MN 56401-1530
Phone (218) 828-4024

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2556MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Miz Inc. CurrentSince May 1, 2021 Accepting new patients
Columbia Park Medical Group, PA Past Accepting new patients
Broecker Eye & Optical Optometrist PastSince Oct 1, 2002 Accepting new patients
Eagan Eye Clinic LLC Optometrist Past Accepting new patients

Locations

15670 Edgewood Dr
Ste 100
Brainerd, MN 56401
Phone (218) 828-4024

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770656845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5924 AMY DR",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554361934",
            "telephone_number": "952-926-2476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2356 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141853",
            "telephone_number": "651-645-8124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWENSON",
        "first_name": "KRISTIN",
        "middle_name": "R.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.