=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356904445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAWYER SCOTT EYECARE CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2019
-----------------------------------------------------
Last Update Date | 01/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 S MAIN ST
-----------------------------------------------------
City | SARDIS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38666-1722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-487-1316
-----------------------------------------------------
Fax | 662-487-9270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 385
-----------------------------------------------------
City | SARDIS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38666-0385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-487-1316
-----------------------------------------------------
Fax | 662-487-9270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SAMUEL SAWYER SCOTT
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 662-487-1316
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------