Healthcare Provider Details

I. General information

NPI: 1609989995
Provider Name (Legal Business Name): SCOTT ELIOT SANZOTTA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAINZ KASTEL OPTOMETRY CLINIC UNIT 29645
APO AE
09096
DE

IV. Provider business mailing address

CMR 467 BOX 3521
APO AE
09096
DE

V. Phone/Fax

Practice location:
  • Phone: 01149-6134204930
  • Fax:
Mailing address:
  • Phone: 011492009826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyX
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4229
License Number StateOH
# 2
Primary TaxonomyX
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35
License Number StateGU
# 3
Primary TaxonomyX
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1659
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: