MEDICARE: THOMAS JON SCZEPANSKI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2418	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2200939	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1669570461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JON SCZEPANSKI O.D.

Provider Business Mailing Address
First Line	:	3675 NOTTINGHAM DR. N.W.
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901
Country	:	US
Telephone Number	:	507-529-3584
Fax Number	:	507-280-9284

Provider Business Practice Location Address
First Line	:	3400 55 ST. N.W.
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901
Country	:	US
Telephone Number	:	507-280-8438
Fax Number	:	507-280-9284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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