MEDICARE: DONALD MAC SCOTHORN 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	0601001669	VA

General Provider Information

NPI Number	:	1013911387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD MAC SCOTHORN O.D.

Provider Business Mailing Address
First Line	:	PO BOX 1789
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24008-1789
Country	:	US
Telephone Number	:	540-344-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 SUMMERFIELD CT
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-4579
Country	:	US
Telephone Number	:	540-966-6616
Fax Number	:

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	04/17/2008

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