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General NPI Number Information
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NPI Number | 1568228625
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Entity Type | Individual
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Provider Name | SCOTT WAYNE CASE LDO
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Gender | Male
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 6111 JEFFERSON AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23605-1511
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Country | US
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Telephone | 757-637-4210
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Fax |
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Provider Business Mailing Address
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Address Line | 8046 ANNES CT
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City | HAYES
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State | VA
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Zip | 23072-3657
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Country | US
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Telephone | 757-525-6281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1101002607
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License Number State | VA
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