Provider Demographics
NPI:1104487966
Name:SCOTT MARKER, BREANNA JO (OD)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:JO
Last Name:SCOTT MARKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:JO
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:518 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1636
Mailing Address - Country:US
Mailing Address - Phone:641-628-2023
Mailing Address - Fax:641-628-2031
Practice Address - Street 1:518 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1636
Practice Address - Country:US
Practice Address - Phone:641-628-2023
Practice Address - Fax:641-628-2031
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096551152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA096551OtherLICENSE