Provider Demographics
NPI:1760555767
Name:CHEPULIS FAMILY EYE CARE, INC.
Entity Type:Organization
Organization Name:CHEPULIS FAMILY EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHEPULIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-351-3976
Mailing Address - Street 1:705 KINGFISHER LN APT C
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1850
Mailing Address - Country:US
Mailing Address - Phone:773-343-1146
Mailing Address - Fax:
Practice Address - Street 1:5815 NORELL AVE N
Practice Address - Street 2:
Practice Address - City:OAK PARK HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55082-1766
Practice Address - Country:US
Practice Address - Phone:651-351-3976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2910152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU79602Medicare UPIN