Provider Demographics
NPI:1205830254
Name:ENDRES, J SCOTT (OD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:SCOTT
Last Name:ENDRES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5730 BOTTINEAU BLVD.
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3181
Mailing Address - Country:US
Mailing Address - Phone:763-537-3213
Mailing Address - Fax:763-537-6732
Practice Address - Street 1:5730 BOTTINEAU BLVD.
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3181
Practice Address - Country:US
Practice Address - Phone:763-537-3213
Practice Address - Fax:763-537-6732
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2303152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22-01181OtherMEDICA PRIMARY
MN410049467OtherMEDICARE RAILROAD
MNHP17523OtherHEALTH PARTNERS
MN130870OtherCOLE MANAGED VISION
MN22-01009OtherSELECT CARE
MN410001614OtherMEDICARE
MN22-01009OtherMEDICA CHOICE
MN23706OtherARAZ/AMERICA'S PPO
MN22-01178OtherMEDICA CHOICE
MN4C413ENOtherBLUE CROSS/BLUE SHIELD
MN109241OtherUCARE SRS AND MN
MN22-01178OtherSELECT CARE
MN320725100Medicaid
MN935300695003OtherPREFERRED ONE
MN644S7ENOtherBLUE CROSS/BLUE SHIELD
MN964110695003OtherPREFERRED ONE