Active NPI
Shawn P Nelson, OD
- Optometrist
- Minot, ND
National Provider Identifier
1891848149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 528
- Practice address
- 2815 16TH St SW
Minot, ND 58701-6914 - Phone
- (701) 857-3500
- Fax
- (701) 857-5792
- NPI assigned
- Jan 19, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 528 | ND | Primary |
Addresses
Primary practice location
2815 16TH St SW
Minot, ND 58701-6914
Mailing address
PO Box 5010
Minot, ND 58702-5010
Phone (701) 857-5650
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60469 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 528 | ND | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337904000000",
"number": "1891848149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5010",
"city": "MINOT",
"state": "ND",
"postal_code": "587025010",
"telephone_number": "701-857-5650",
"fax_number": "701-857-5031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2815 16TH ST SW",
"city": "MINOT",
"state": "ND",
"postal_code": "587016914",
"telephone_number": "701-857-3500",
"fax_number": "701-857-5792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "SHAWN",
"middle_name": "P",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-19",
"last_updated": "2012-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ND",
"license": "528",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60469",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minot, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.