OPTOMETRY CLINIC, PC
NPI 1225686827
Optometrist in Kenmare, ND
About Optometry Clinic, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
OPTOMETRY CLINIC, PC (NPI 1225686827) is a healthcare organization registered as an optometrist in Kenmare, North Dakota and active in the NPI registry since August 2019. The organization maintains a secondary practice location in Stanley and lists Tesha Gustafson, Owner/optometrist, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Optometry Clinic, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Optometry Clinic, PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Medical Equipment Supplier Medicare DMEPOS 2
Medicare supplier enrollment and the product categories Optometry Clinic, PC carries, from the Medicare DMEPOS supplier directory.
Optometry Clinic, PC
DMEPOS supplier · Kenmare, NDAccepts Medicare assignment
Optometry Clinic, PC agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Product Categories
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Optometry Clinic, PC's NPI number?
The NPI number for Optometry Clinic, PC is 1225686827. It was assigned to this organization in the NPPES registry on August 28, 2019.
Where is Optometry Clinic, PC located?
Optometry Clinic, PC is located at 28 2nd St NW, Kenmare, ND 58746. The listed phone number is (701) 385-4004.
What is Optometry Clinic, PC's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Optometry Clinic, PC enrolled in Medicare?
Yes. Optometry Clinic, PC is registered in the Medicare PECOS enrollment system.
When is Optometry Clinic, PC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare DME enrollment for this organization (North Dakota, Physician - Optometrist) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Optometry Clinic, PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Optometry) reassigns their Medicare billing to Optometry Clinic, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Optometry Clinic, PC accept Medicare assignment for medical equipment?
Yes. As a Medicare medical equipment supplier, Optometry Clinic, PC accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.
What insurance does Optometry Clinic, PC accept?
Health plans from Blue Cross Blue Shield of North Dakota and Sanford Health Plan list Optometry Clinic, PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Optometry Clinic, PC was last updated on September 18, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Optometry Clinic, Pc · NPI 1225686827
Optometrist organization in Kenmare, North Dakota. Organization record, active in the CMS NPPES registry since August 28, 2019.
## Identity
- **NPI:** 1225686827 (Entity type: Organization)
- **Enumerated:** August 28, 2019
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **Organization subpart:** No
- **Authorized official:** Tesha Gustafson, OWNER/OPTOMETRIST
## Practice location
- **Address:** 28 2ND ST NW, Kenmare, ND 58746-7114
- **Phone:** (701) 385-4004 · **Fax:** (701) 385-4005
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (DME, North Dakota, Physician - Optometrist) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Optometry) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 18, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1225686827) · Data from the CMS NPPES public registry.