MEDICARE: SCOTT NYGARD O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	CA5918T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265434286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT NYGARD O.D.

Provider Business Mailing Address
First Line	:	7325 GREENBACK LN
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-5530
Country	:	US
Telephone Number	:	916-969-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	7325 GREENBACK LN
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-5530
Country	:	US
Telephone Number	:	916-969-2424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	12/31/2008

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Directions to “ SCOTT NYGARD O.D.” Practice Location

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