MEDICARE: SCOTT D CLOUGH OD

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	OPC-2165	FL

General Provider Information

NPI Number	:	1326042375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT D CLOUGH OD

Provider Business Mailing Address
First Line	:	9409 US HIGHWAY 19 STE 101
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4626
Country	:	US
Telephone Number	:	727-859-9009
Fax Number	:

Provider Business Practice Location Address
First Line	:	9409 US HIGHWAY 19 STE 101
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4626
Country	:	US
Telephone Number	:	727-859-9009
Fax Number	:

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/30/2007

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