Suzette Skavlem, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3770 Issued in MN

Practice address

3840 Grand Way
St Louis Park, MN 55416-4788

Phone

(952) 848-2020

Fax

(952) 922-2015

NPI assigned

Sep 4, 2018

Sex

Female

Sole proprietor

No

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

Southern California College of Optometry, 2018

Medicare assignment

May accept Medicare assignment

Group practices

Roman Gerber LLCGroup PAC ID 2860720893, 3 clinicians

Sarah K Ebeling OD PLLCGroup PAC ID 5092037200, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Roman Gerber LLC

  dba Wink Family Eye Care of SLP

  • Optometrist
  • St Louis Park, MN
  • NPI 1306365846
  Medicare reassignment Care Compare group NPD
• Sarah K. Ebeling, OD, PLLC

  dba Wink Family Eye Care

  • Optometrist
  • Chanhassen, MN
  • NPI 1336541408
  Medicare reassignment Care Compare group NPD
• Crystal Vision Clinic PA

  • Optometrist
  • Crystal, MN
  • NPI 1720480007
  Medicare reassignment NPD
• James J Hess & Scott Endres

  dba Crystal Vision Clinic

  • Optometrist
  • Crystal, MN
  • NPI 1215934880
  NPD (past)

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

{
    "created_epoch": "1536019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1790267987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3840 GRAND WAY",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164788",
            "telephone_number": "952-848-2020",
            "fax_number": "952-922-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 GRAND WAY",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164788",
            "telephone_number": "952-848-2020",
            "fax_number": "952-922-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKAVLEM",
        "first_name": "SUZETTE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-04",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mahilet Sisay, CNP
• Erica H Sitton, OTR/L
• Mary Elizabeth Siusta
• Allison Taylor Sivanich, OTR/L
• Deborah E Skansberg, PT
• Rachel Elise Skaw, D.P.T.
• Megan Lynn Skelton
• Anthony John Skinner, DDS
• Diane M Skinner, OTR/L
• Marika Skodje

• Optometrist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.