Basic Information
| Provider Information | |||||||||
| NPI: | 1891716742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEPULIS | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 KINGFISHER LN APT C | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551251850 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1785 RADIO DR STE B | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551255400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6515010920 | ||||||||
| FaxNumber: | 6515010921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2910 | MN | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.