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General NPI Number Information
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NPI Number | 1942394937
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Entity Type | Individual
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Provider Name | SCOTT ELLIS POTTER I O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 19 NW BARRY RD
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City | KANSAS CITY
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State | MO
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Zip | 64155-2728
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Country | US
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Telephone | 816-468-4680
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Fax | 816-468-6444
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Provider Business Mailing Address
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Address Line | 3509 NW 85TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64154-1157
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Country | US
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Telephone | 816-436-4786
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | MO-T-2750
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License Number State | MO
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