Provider Demographics
NPI:1154597391
Name:SCOTT REAM OPTOMETRY PC
Entity type:Organization
Organization Name:SCOTT REAM OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:REAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-264-7418
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:THAYER
Mailing Address - State:MO
Mailing Address - Zip Code:65791-0157
Mailing Address - Country:US
Mailing Address - Phone:417-264-7418
Mailing Address - Fax:417-264-2838
Practice Address - Street 1:207 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:THAYER
Practice Address - State:MO
Practice Address - Zip Code:65791-1203
Practice Address - Country:US
Practice Address - Phone:417-264-7418
Practice Address - Fax:417-264-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02734332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO42799Medicare UPIN
MO4287690001Medicare NSC
MO000091295Medicare PIN