Provider Demographics
NPI:1043214091
Name:FRICK, SCOTT A (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:FRICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13645 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4405
Mailing Address - Country:US
Mailing Address - Phone:763-420-8030
Mailing Address - Fax:763-420-9842
Practice Address - Street 1:13645 GROVE DR N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-4405
Practice Address - Country:US
Practice Address - Phone:763-420-8030
Practice Address - Fax:763-420-9842
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP30592OtherHEALTH PARTNERS
MN165185OtherCOLE MANAGED VISION
MN22-01181OtherMEDICA PRIMARY
MN22-08371OtherSELECT CARE
MN935301023286OtherPREFERRED ONE
MN22-01177OtherMEDICA CHOICE
MN36B91FROtherBLUE CROSS/BLUE SHIELD
MN410049439OtherMEDICARE RAILROAD
MN9641110232861OtherPREFERRED ONE
MN410001615OtherMEDICARE
MN22-08371OtherMEDICA CHOICE
MN410045202OtherMEDICARE RAILROAD
MN22-01177OtherSELECT CARE
MN009560500Medicaid
MN150163OtherUCARE SRS AND MN
MN644S8FROtherBLUE CROSS/BLUE SHIELD
MN862671OtherARAZ/AMERICA'S PPO