Provider Demographics
NPI:1588872147
Name:SCOTT, JENNIFER L (OF)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OF
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Mailing Address - Street 1:8251 FLYING CLOUD DR
Mailing Address - Street 2:SUITE 2024
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5350
Mailing Address - Country:US
Mailing Address - Phone:952-944-3131
Mailing Address - Fax:952-944-9675
Practice Address - Street 1:8251 FLYING CLOUD DR
Practice Address - Street 2:SUITE 2024
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5350
Practice Address - Country:US
Practice Address - Phone:952-944-3131
Practice Address - Fax:952-944-9675
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU29645Medicare UPIN
MN410000355Medicare ID - Type Unspecified