Shannon Koenders Veldkamp, OD

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

3577 Issued in MN

Practice address

12771 Riverdale Blvd NW
Coon Rapids, MN 55448-1262

Phone

(763) 421-1220

Fax

(763) 421-1291

NPI assigned

Jun 25, 2018

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Enrolled

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.

• MLP Optometry LTD

  • Optometrist
  • Saint Cloud, MN
  • NPI 1801454608
  Medicare reassignment NPD
• Visionary Eye Care, PA

  • Optometrist
  • Excelsior, MN
  • NPI 1811430226
  Medicare reassignment NPD
• Ocularra Holding. Inc

  • Optometrist
  • Blaine, MN
  • NPI 1356498075
  NPD (past)

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696204800000",
    "number": "1902391626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19879 NAPLES ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553308859",
            "telephone_number": "605-941-9628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12771 RIVERDALE BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554481262",
            "telephone_number": "763-421-1220",
            "fax_number": "763-421-1291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3636 2nd St S",
            "address_purpose": "LOCATION",
            "city": "St Cloud",
            "state": "MN",
            "postal_code": "563013732",
            "country_code": "US",
            "telephone_number": "320-316-9880",
            "fax_number": "320-316-9881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VELDKAMP",
        "first_name": "SHANNON",
        "middle_name": "KOENDERS",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-25",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MN",
            "license": "3577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sridevi Vasa, MD
• Vayda Mental Health Collaborative PLLC
• Nutan Jyothi Vaz, M.D.
• Jeremy Vazquez-Kessel
• Lyla Veen, M.D
• Arvind Vemula, MD
• James Conrad Verkuilen, OD
• Rajanshu Verma, MD
• Erin Ann Vesey, DPT
• Amanda Vestal, LPCC, LADC

• Vision Therapy Optometrist in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Vision Therapy Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.