Healthcare Provider Details

I. General information

NPI: 1942229984
Provider Name (Legal Business Name): SCOTT C SO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST STE 302
SAN FRANCISCO CA
94115-2376
US

IV. Provider business mailing address

2100 WEBSTER ST STE 302
SAN FRANCISCO CA
94115-2376
US

V. Phone/Fax

Practice location:
  • Phone: 415-704-4899
  • Fax:
Mailing address:
  • Phone: 415-704-4899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA82180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: