Individual provider Active NPI

Nathan L. Vetter, OD

  • Optometrist
  • Fargo, ND
National Provider Identifier
1922064633
Registry record updated Jul 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2934 Issued in MN
Practice address
2101 Elm St N
Fargo, ND 58102-2417
Phone
(701) 232-3241
Fax
(701) 237-2690
NPI assigned
Apr 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2007

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2897T OR
Optometrist 152W00000X 2934 MN Primary
Optometrist 152W00000X 3807 WA

Addresses

Primary practice location

2101 Elm St N
Fargo, ND 58102-2417

Mailing address

2101 Elm St N
Fargo, ND 58102-2417
Phone (701) 232-3241

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20130523000314 ND Order and Referring Only - OptometryPractitioner - Optometry 3577701036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2897TORMDOptometrist
3807WAMDOptometrist
2934MNMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184198400000",
    "number": "1922064633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 ELM ST N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581022417",
            "telephone_number": "701-232-3241",
            "fax_number": "701-237-2690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 ELM ST N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581022417",
            "telephone_number": "701-232-3241",
            "fax_number": "701-237-2690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VETTER",
        "first_name": "NATHAN",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2007-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2897T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2934",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "3807",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.