MEDICARE: DR. SCOTT MCDOWELL 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	4901004221	MI

General Provider Information

NPI Number	:	1689662173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT MCDOWELL O.D.

Provider Business Mailing Address
First Line	:	2472 S LONG LAKE RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1462
Country	:	US
Telephone Number	:	810-714-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2472 S LONG LAKE RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1462
Country	:	US
Telephone Number	:	810-714-2020
Fax Number	:

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	10/16/2014

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