Provider Demographics
NPI:1437254455
Name:TELANDER, SCOTT R (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:TELANDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:20 LAKE ST N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2523
Mailing Address - Country:US
Mailing Address - Phone:651-464-4824
Mailing Address - Fax:651-464-0003
Practice Address - Street 1:20 LAKE ST N
Practice Address - Street 2:SUITE 101
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2523
Practice Address - Country:US
Practice Address - Phone:651-464-4824
Practice Address - Fax:651-464-0003
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2990152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN807044000Medicaid
MN807044000Medicaid