Healthcare Provider Details

I. General information

NPI: 1255432274
Provider Name (Legal Business Name): SCOTT M DENISON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 12TH ST
JEFFERSONVILLE IN
47130-3834
US

IV. Provider business mailing address

100 E 12TH ST
JEFFERSONVILLE IN
47130-3834
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-7179
  • Fax: 812-282-0203
Mailing address:
  • Phone: 812-288-7179
  • Fax: 812-282-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001727B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: