Healthcare Provider Details

I. General information

NPI: 1679438857
Provider Name (Legal Business Name): SCOTT EYE & VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1187 JOHN SIMS PKWY E
NICEVILLE FL
32578-2752
US

IV. Provider business mailing address

200 PAGE BACON RD APT 2415
MARY ESTHER FL
32569-1763
US

V. Phone/Fax

Practice location:
  • Phone: 619-321-7521
  • Fax:
Mailing address:
  • Phone: 619-321-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN SCOTT
Title or Position: CHIEF OPERATING OFFICER
Credential: OD
Phone: 619-321-7521