Healthcare Provider Details

I. General information

NPI: 1407988694
Provider Name (Legal Business Name): SCOTT A. GARTNER, OD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 TIFFANY DR E
WEST PALM BEACH FL
33407-3242
US

IV. Provider business mailing address

5944 CORAL RIDGE DR #210
CORAL SPRINGS FL
33076-3300
US

V. Phone/Fax

Practice location:
  • Phone: 561-586-5600
  • Fax: 866-425-2030
Mailing address:
  • Phone: 954-557-5913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPC1411
License Number StateFL

VIII. Authorized Official

Name: DR. SCOTT ALAN GARTNER
Title or Position: PRESIDENT
Credential: OD
Phone: 954-557-5913