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General NPI Number Information
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NPI Number | 1518277672
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Entity Type | Organization
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Legal Business Name | SCOTT D. FISCUS
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 2611 WESTWOOD DR SUITE A
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City | NASHVILLE
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State | TN
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Zip | 37204-2709
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Country | US
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Telephone | 615-361-0930
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Fax | 615-467-7507
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Provider Business Mailing Address
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Address Line | 2611 WESTWOOD DR SUITE A
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City | NASHVILLE
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State | TN
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Zip | 37204-2709
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Country | US
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Telephone | 615-361-0930
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Fax | 615-467-7507
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Authorized Official
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Title or Position | OWNER
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Name | MR. SCOTT D FISCUS
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Credential | B.C.O.
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Telephone | 615-361-0930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 02-294-20
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number |
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License Number State |
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