Healthcare Provider Details

I. General information

NPI: 1669584140
Provider Name (Legal Business Name): DAWN ANISE SCOTT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WALMART DR
NORTH VERSAILLES PA
15137-1535
US

IV. Provider business mailing address

313 SHARON DR
PITTSBURGH PA
15221-4029
US

V. Phone/Fax

Practice location:
  • Phone: 412-816-2272
  • Fax: 412-816-2275
Mailing address:
  • Phone: 412-816-2272
  • Fax: 412-816-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000432
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: