NPIMap

Individual provider Active NPI

Scott P Chepulis, OD

  • Optometrist
  • Woodbury, MN
National Provider Identifier
1891716742
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2910 Issued in MN
Practice address
1785 Radio Dr Ste B
Woodbury, MN 55125-5400
Phone
(651) 501-0920
Fax
(651) 501-0921
NPI assigned
Jul 23, 2006
Sex
Male
Sole proprietor
Yes

Organizations & group practices 20

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Visionworks Inc 10 clinicians

Practice addresses (Care Compare)

200 Western Ave
Suite D5
Fairbault, MN 55021-4503
Phone (507) 334-7941

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20040119000732 MN Practitioner - Optometry 8224939590 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2910MNMDNeonatal/Pediatric Certified Respiratory Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Vision World Inc Past Accepting new patients
Visionworks Inc Past Accepting new patients
Vision World Inc Past Accepting new patients
Chepulis Family Eye Care, Inc. Optometrist Past Accepting new patients

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2910 MN Primary

Addresses

NPPES NPI Registry

Primary practice location

1785 Radio Dr Ste B
Woodbury, MN 55125-5400

Mailing address

705 Kingfisher LN Apt C
Woodbury, MN 55125-1850

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891716742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 KINGFISHER LN APT C",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1785 RADIO DR STE B",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255400",
            "telephone_number": "651-501-0920",
            "fax_number": "651-501-0921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEPULIS",
        "first_name": "SCOTT",
        "middle_name": "P",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.