Healthcare Provider Details

I. General information

NPI: 1346343928
Provider Name (Legal Business Name): SCOTT D FISCUS B.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 WESTWOOD DR SUITE A
NASHVILLE TN
37204-2709
US

IV. Provider business mailing address

2611 WESTWOOD DR SUITE A
NASHVILLE TN
37204-2709
US

V. Phone/Fax

Practice location:
  • Phone: 615-361-0930
  • Fax: 615-467-7507
Mailing address:
  • Phone: 615-361-0930
  • Fax: 615-467-7507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number02294-14
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: