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NPI Code Detail

MEDICARE: DR. NICOLETTE E SCOTT O.D.

MEDICARE: DR. NICOLETTE E SCOTT 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
1152W00000XOptometristOH5247OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13765222OTHEROHAETNA (RP)
237666535OTHEROHAETNA (SL)
3000000360728OTHEROHANTHEM (RP)
4000000360729OTHEROHANTHEM (SL)

General Provider Information

NPI Number : 1770621088
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICOLETTE E SCOTT O.D.
Provider Business Mailing Address
First Line : 1261 W ROYALTON RD
Second Line :
City : BROADVIEW HEIGHTS
State : OH
Zip : 44147-2407
Country : US
Telephone Number : 440-526-7070
Fax Number : 440-526-6330
Provider Business Practice Location Address
First Line : 1261 W ROYALTON RD
Second Line :
City : BROADVIEW HEIGHTS
State : OH
Zip : 44147-2407
Country : US
Telephone Number : 440-526-7070
Fax Number : 440-526-6330
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 05/18/2023

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