=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215934880
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES J HESS & SCOTT ENDRES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2005
-----------------------------------------------------
Last Update Date | 08/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5200 DOUGLAS DR N
-----------------------------------------------------
City | CRYSTAL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55429-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-537-3213
-----------------------------------------------------
Fax | 763-537-6732
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5200 DOUGLAS DR N
-----------------------------------------------------
City | CRYSTAL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55429-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-537-3213
-----------------------------------------------------
Fax | 763-537-6732
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER/OPTOMETRIST
-----------------------------------------------------
Name | JAMES J HESS
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 763-537-3213
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3117442
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------