MEDICARE: MR. SCOTT MICHAEL ACKERMAN 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	1799	KS

General Provider Information

NPI Number	:	1770749160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT MICHAEL ACKERMAN O.D.

Provider Business Mailing Address
First Line	:	802 N CAMPUS DR
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-6342
Country	:	US
Telephone Number	:	620-275-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 CASEYS DR
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-3314
Country	:	US
Telephone Number	:	620-275-5375
Fax Number	:	620-275-2036

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	11/13/2018

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