Healthcare Provider Details

I. General information

NPI: 1588659593
Provider Name (Legal Business Name): SCOTT W BARTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PINE GRV
PORT HURON MI
48060-3733
US

IV. Provider business mailing address

PO BOX 26010
FRASER MI
48026-6010
US

V. Phone/Fax

Practice location:
  • Phone: 810-982-3200
  • Fax: 810-982-4480
Mailing address:
  • Phone: 586-296-7250
  • Fax: 586-296-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5101013776
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: