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General NPI Number Information
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NPI Number | 1790966646
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Entity Type | Organization
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Legal Business Name | SCOTT M. BUCKINGHAM, OD PC
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 2808 W WACKERLY ST SUITE 1
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City | MIDLAND
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State | MI
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Zip | 48640-6997
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Country | US
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Telephone | 989-636-7580
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Fax | 989-636-7583
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Provider Business Mailing Address
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Address Line | 2808 W WACKERLY ST SUITE 1
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City | MIDLAND
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State | MI
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Zip | 48640-6997
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Country | US
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Telephone | 989-636-7580
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Fax | 989-636-7583
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JERI L OVERLY
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Credential | ABOC, NAO
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Telephone | 989-636-7580
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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 | 003193
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License Number State | MI
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