Provider Demographics
NPI:1366515272
Name:JEPPSON, STEVEN P (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:JEPPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 1ST AVE S
Mailing Address - Street 2:PO BOX 110
Mailing Address - City:SAINT JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081-1727
Mailing Address - Country:US
Mailing Address - Phone:507-375-4941
Mailing Address - Fax:507-375-3610
Practice Address - Street 1:517 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-1727
Practice Address - Country:US
Practice Address - Phone:507-375-4941
Practice Address - Fax:507-375-3610
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1704152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT65655Medicare UPIN
MN42296Medicare ID - Type Unspecified