| Kennedy Vision Health Center, Llc | |
|
10600 Old County Road 15, Plymouth, MN 55441-6210 | |
| (763) 545-8850 | |
| (763) 544-1257 |
| Full Name | Kennedy Vision Health Center, Llc |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 10600 Old County Road 15, Plymouth, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033203963 | NPI | - | NPPES |
| 01040808 | Other | MN | PREFERRED ONE |
| 417R4KE | Other | MN | BCBS |
| DB1166 | Other | MN | RAILROAD MEDICARE |
| 170285 | Other | MN | UCARE |
| 99240 | Other | MN | HEALTH PARTNERS |
| 2115782 | Other | MN | MEDICA |
| 620020600 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | (* (Not Available)) | Primary |
| Provider Name | Anthony C Traverse |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1255431961 PECOS PAC ID: 2668466335 Enrollment ID: I20040414000639 |
| Provider Name | Kimberley A Bugajski |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1962503524 PECOS PAC ID: 4587658281 Enrollment ID: I20040414000871 |
| Provider Name | David L Kennedy |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1437250073 PECOS PAC ID: 4385638105 Enrollment ID: I20040415000184 |
| Provider Name | Jesse William Rossow |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1649617614 PECOS PAC ID: 0143469031 Enrollment ID: I20130626000163 |
| Provider Name | Deanna Lynn Sell |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1598324014 PECOS PAC ID: 4486989480 Enrollment ID: I20190712002333 |
| Provider Name | Kelsey J Moore |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1154844017 PECOS PAC ID: 1759711120 Enrollment ID: I20200427000837 |
| Provider Name | Chase Edward Eder |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1235878950 PECOS PAC ID: 6709257793 Enrollment ID: I20230131001221 |
| Mailing Address | Practice Location Address |
|---|---|
| Kennedy Vision Health Center, Llc 10600 Old County Road 15, Plymouth, MN 55441-6210 Ph: (763) 545-8850 | Kennedy Vision Health Center, Llc 10600 Old County Road 15, Plymouth, MN 55441-6210 Ph: (763) 545-8850 |
John Mueller Od Pc Optometrist Medicare: Medicare Enrolled Practice Location: 4190 Vinewood Ln N Ste 109, Plymouth, MN 55442 Phone: 763-559-5522 Fax: 763-559-7122 | |
Nicole Ann Solem, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 4455 Highway 169 N, Plymouth, MN 55442 Phone: 763-559-7358 | |
Dr. Kelsey Moore, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 10600 Old County Road 15, Plymouth, MN 55441 Phone: 763-545-8850 Fax: 763-544-1257 | |
Visionsmith Inc Optometrist Medicare: Not Enrolled in Medicare Practice Location: 4190 Vinewood Ln N, Suite 109, Plymouth, MN 55442 Phone: 763-559-5522 Fax: 763-559-7122 | |
Dr. Nadia Siddiqi Khan, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 3007 Harbor Ln N Ste 1500, Plymouth, MN 55447 Phone: 763-559-4669 Fax: 763-559-4767 | |
Chase Edward Eder, OD Optometrist Medicare: Medicare Enrolled Practice Location: 10600 Old County Road 15, Plymouth, MN 55441 Phone: 763-452-9381 |