MEDICARE: DR. ROGER W SCOTT JR. 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	1253	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1831185867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER W SCOTT JR. O.D.

Provider Business Mailing Address
First Line	:	4075 MARIETTA HWY
Second Line	:	110
City	:	DALLAS
State	:	GA
Zip	:	30157-3315
Country	:	US
Telephone Number	:	770-445-9866
Fax Number	:	770-445-8244

Provider Business Practice Location Address
First Line	:	4075 MARIETTA HWY
Second Line	:	110
City	:	DALLAS
State	:	GA
Zip	:	30157-3315
Country	:	US
Telephone Number	:	770-445-9866
Fax Number	:	770-445-8244

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	01/06/2015

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