Ashley Marie Motacek, O.D.
Individual provider Active NPI Optometrist · Fargo, ND
NPI 1780919340 · NPPES record last updated Jul 12, 2022
Key facts
- NPI
- 1780919340
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 700 (ND)
- Practice address
- 2553 Kirsten LN S Ste 202
Fargo, ND 58104-4901 - Phone
- (701) 373-2020
- Fax
- (701) 373-0021
- NPI assigned
- Oct 14, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- 20-20 Vision Express LLC
Practice addresses (Care Compare)
1300 Gateway Dr S
Fargo, ND 58103-3509
Phone (701) 235-0280
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- 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 |
|---|---|---|---|---|
| I20121106000371 | ND | Practitioner - Optometry | 0244481968 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 700 | ND | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 20-20 Vision Express LLC | Current |
Accepting new patients | |
| Lifetime Vision 20/20 | Optometrist | Past |
Accepting new patients |
Locations
1300 Gateway Dr S
Fargo, ND 58103
Phone (701) 232-6683
1300 Gateway Dr S
Ste 3
Fargo, ND 58103
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Optometrist | 152W00000X | 700 | ND | Yes |
Addresses
Primary practice location
2553 Kirsten LN S Ste 202
Fargo, ND 58104-4901
Mailing address
2553 Kirsten LN S Ste 202
Fargo, ND 58104-4901
Phone (701) 373-2020
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | drmotacek@optixgallery.com | Direct |
Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2022. 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.