MEDICARE: DR. DIANA MEADE SCOGGIN OD

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	T02691	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	117301	OTHER		BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407842156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA MEADE SCOGGIN OD

Provider Business Mailing Address
First Line	:	PO BOX 1887
Second Line	:
City	:	CAMDENTON
State	:	MO
Zip	:	65020-1887
Country	:	US
Telephone Number	:	573-346-5951
Fax Number	:	573-346-3252

Provider Business Practice Location Address
First Line	:	117 S BUSINESS ROUTE 5
Second Line	:
City	:	CAMDENTON
State	:	MO
Zip	:	65020-1887
Country	:	US
Telephone Number	:	573-346-5951
Fax Number	:	573-346-3252

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	03/03/2010

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