Individual provider Active NPI

Kristina M Borespupp, OD

  • Optometrist
  • Plymouth, MN
National Provider Identifier
1831159680
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2479 Issued in MN
Practice address
4455 Highway 169 N
Plymouth, MN 55442-2897
Phone
(763) 551-0529
Fax
(763) 559-6010
NPI assigned
Mar 24, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2479 MN Primary

Addresses

Primary practice location

4455 Highway 169 N
Plymouth, MN 55442-2897

Mailing address

3715 Marsh PT W
Independence, MN 55359-9820
Phone (763) 479-3794

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
I20050509000028 MN Practitioner - Optometry 4082654132 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University Alabama Birmingham - School of Optometry, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Don Sealock OD PAGroup PAC ID 5092755215, 6 clinicians

Practice addresses (Care Compare)

4455 Hwy 169 N
Plymouth, MN 55442
Phone (763) 746-3391

Merit-based Incentive Payment System (MIPS)

Final score
92.01 of 100Reported as group
Quality
84.02
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Don Sealock, O.D., P.a. PastSince Jan 10, 2005 Accepting new patients
Hometown Eye Care, Inc Optometrist Past Accepting new patients
Don Sealock, O.D., P.a. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kristina.borespupp.p1@direct.eyecarepartners.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1831159680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3715 MARSH PT W",
            "city": "INDEPENDENCE",
            "state": "MN",
            "postal_code": "553599820",
            "telephone_number": "763-479-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 HIGHWAY 169 N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554422897",
            "telephone_number": "763-551-0529",
            "fax_number": "763-559-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORESPUPP",
        "first_name": "KRISTINA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-24",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.