Healthcare Provider Details

I. General information

NPI: 1124082268
Provider Name (Legal Business Name): SCOTT & PIERCE OPTOMETRY. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 E BRADFORD PKWY
SPRINGFIELD MO
65804-6563
US

IV. Provider business mailing address

1426 E BRADFORD PKWY
SPRINGFIELD MO
65804-6563
US

V. Phone/Fax

Practice location:
  • Phone: 417-887-7151
  • Fax: 417-887-7153
Mailing address:
  • Phone: 417-887-7151
  • Fax: 417-887-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberD02560
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02881
License Number StateMO

VIII. Authorized Official

Name: DR. CAROL L SCOTT
Title or Position: PRESIDENT
Credential: O.D.
Phone: 417-887-7151