Provider Demographics
NPI:1124082268
Name:SCOTT & PIERCE OPTOMETRY. P.C.
Entity type:Organization
Organization Name:SCOTT & PIERCE OPTOMETRY. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-887-7151
Mailing Address - Street 1:1426 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6563
Mailing Address - Country:US
Mailing Address - Phone:417-887-7151
Mailing Address - Fax:417-887-7153
Practice Address - Street 1:1426 E BRADFORD PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6563
Practice Address - Country:US
Practice Address - Phone:417-887-7151
Practice Address - Fax:417-887-7153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOD02560152W00000X
MOT02881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312243819Medicaid
MO318111408Medicaid
U71763Medicare UPIN
MO318111408Medicaid
MO1110960001Medicare NSC
MO990001471Medicare ID - Type UnspecifiedOPTOMETRIS