=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417160748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEAN B. SCOTT, OCULARIST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 S OSPREY AVE
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-388-4455
-----------------------------------------------------
Fax | 239-997-4455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1319 BUTTERFIELD RD SUITE 524
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60515-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-960-4455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DEAN SCOTT
-----------------------------------------------------
Credential | F.C.O.
-----------------------------------------------------
Telephone | 941-388-4455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------