Healthcare Provider Details

I. General information

NPI: 1609874536
Provider Name (Legal Business Name): DAVID E SCOTT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6004 SW 9TH ST
DES MOINES IA
50315-5011
US

IV. Provider business mailing address

6004 SW 9TH ST
DES MOINES IA
50315-5011
US

V. Phone/Fax

Practice location:
  • Phone: 515-287-0820
  • Fax: 515-287-0938
Mailing address:
  • Phone: 515-287-0820
  • Fax: 515-287-0938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1597DPAT
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: