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General NPI Number Information
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NPI Number | 1245309095
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Entity Type | Organization
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Legal Business Name | SCOTT EYE CARE P L L C
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 400 S MAIN ST
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City | SHATTUCK
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State | OK
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Zip | 73858
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Country | US
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Telephone | 580-938-5210
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Fax | 580-938-2166
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Provider Business Mailing Address
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Address Line | PO BOX 770
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City | SHATTUCK
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State | OK
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Zip | 73858-0770
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Country | US
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Telephone | 580-938-5210
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Fax | 580-938-2166
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. DAVID C JONES
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Credential | O.D.
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Telephone | 580-938-5210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2374
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License Number State | OK
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