MEDICARE: DR. DUSTIN MICHAEL SCOTT 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	OPC6547	FL

General Provider Information

NPI Number	:	1528800240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN MICHAEL SCOTT OD

Provider Business Mailing Address
First Line	:	1904 LAGRANGE RD
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-1690
Country	:	US
Telephone Number	:	619-321-7521
Fax Number	:

Provider Business Practice Location Address
First Line	:	778 BEAL PKWY N UNIT 102
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-3063
Country	:	US
Telephone Number	:	619-321-7521
Fax Number	:

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

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	07/24/2024

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