Provider Demographics
NPI:1215116306
Name:SCOTT O MCDONALD OD PA
Entity type:Organization
Organization Name:SCOTT O MCDONALD OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:OD PA
Authorized Official - Phone:828-254-1821
Mailing Address - Street 1:1000 HAYWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2651
Mailing Address - Country:US
Mailing Address - Phone:828-254-1821
Mailing Address - Fax:828-251-9694
Practice Address - Street 1:1000 HAYWOOD ROAD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2651
Practice Address - Country:US
Practice Address - Phone:828-254-1821
Practice Address - Fax:828-251-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909593Medicaid
NC0387920001Medicare NSC
NC2471958Medicare PIN