Plymouth Vision Center, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PLYMOUTH VISION CENTER, INC.

Practice address

3007 Harbor LN N Ste 1500
Plymouth, MN 55447-5103

Phone

(763) 559-4669

Fax

(763) 559-4767

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Tate Herman, ODNPI 1982895439

Title

Owner

Phone

(763) 559-4669

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tate Herman, OD

  • Optometrist
  • Plymouth, MN
  • NPI 1982895439
  Medicare reassignment Care Compare group NPD Authorized official
• Nadia Siddiqi Khan, O.D.

  • Optometrist
  • Plymouth, MN
  • NPI 1235350745
  Medicare reassignment Care Compare group NPD
• Ara C. Gerard, O.D.

  • Optometrist
  • Minnetonka, MN
  • NPI 1841356532
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665360000000",
    "number": "1902943822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3007 HARBOR LN N STE 1500",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554475103",
            "telephone_number": "763-559-4669",
            "fax_number": "763-559-4767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3007 HARBOR LN N STE 1500",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554475103",
            "telephone_number": "763-559-4669",
            "fax_number": "763-559-4767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH VISION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A",
        "authorized_official_last_name": "HERMAN",
        "authorized_official_first_name": "TATE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-559-4669",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS OF MN",
            "identifier": "16F68PL",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Plymouth Plaza Dental
• Plymouth Psych Group, LLC
• Plymouth Senior Housing, LLC
• Plymouth Smiles Dentistry, PC
• Plymouth Station Dental, PA
• Samantha Jo Poehling, PA-C
• Sara Poff
• Leila Ann Pollock, NP
• Robert A Pollock, MD
• Tim Richard Portinga, PSYD LP

• Optometrist in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.