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General NPI Number Information
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NPI Number | 1114115433
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Entity Type | Organization
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Legal Business Name | SCOTT EYE CLINIC PA
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 02/12/2018
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Provider Practice Location Address
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Address Line | 214 E 4TH ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5134
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Country | US
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Telephone | 479-968-3937
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Fax | 479-967-6731
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Provider Business Mailing Address
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Address Line | 214 E 4TH ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5134
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Country | US
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Telephone | 479-968-3937
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Fax | 479-967-6731
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. HENRY KEITH SCOTT
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Credential | OD
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Telephone | 479-968-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2349
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License Number State | AR
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