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General NPI Number Information
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NPI Number | 1770892077
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Entity Type | Organization
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Legal Business Name | SCOTT E BAILEY OD PC
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 5919 HARBOUR PARK DR
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2163
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Country | US
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Telephone | 804-739-8646
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Fax | 804-739-9651
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Provider Business Mailing Address
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Address Line | 5919 HARBOUR PARK DR
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2163
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Country | US
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Telephone | 804-739-8646
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Fax | 804-739-9651
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT E BAILEY
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Credential | OD
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Telephone | 804-739-8646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1404
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License Number State | VA
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