1215934880 NPI number — JAMES J HESS & SCOTT ENDRES

Table of content: (NPI 1215934880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215934880 NPI number — JAMES J HESS & SCOTT ENDRES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES J HESS & SCOTT ENDRES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CRYSTAL VISION CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215934880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 DOUGLAS DR N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55429-3104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-537-3213
Provider Business Mailing Address Fax Number:
763-537-6732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5200 DOUGLAS DR N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRYSTAL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55429-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-537-3213
Provider Business Practice Location Address Fax Number:
763-537-6732
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HESS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PARTNER/OPTOMETRIST
Authorized Official Telephone Number:
763-537-3213

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3117442 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 144823400 . This is a "MA - DISP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 101878 . This is a "UCARE SRS ANDMN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 10184LU . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 21-15970 . This is a "MEDICA CHOICE DISP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 615 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 130829 . This is a "COLE MANAGED VISION" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 419272900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK7217 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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