Provider Demographics
NPI:1568733038
Name:TONI SCHEPER, OD
Entity Type:Organization
Organization Name:TONI SCHEPER, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-270-1907
Mailing Address - Street 1:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-0618
Mailing Address - Country:US
Mailing Address - Phone:952-270-1907
Mailing Address - Fax:612-808-5023
Practice Address - Street 1:1063 BURNSVILLE CTR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4447
Practice Address - Country:US
Practice Address - Phone:952-435-8821
Practice Address - Fax:612-808-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-15
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2331152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN420525100Medicaid
MN410003723OtherMEDICARE ID