Provider Demographics
NPI:1285770537
Name:SEO, SCOTT MOOHUN (MD, PHD)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MOOHUN
Last Name:SEO
Suffix:
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:3715 MAIN ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3618
Mailing Address - Country:US
Mailing Address - Phone:203-372-4211
Mailing Address - Fax:203-372-4142
Practice Address - Street 1:3715 MAIN ST
Practice Address - Street 2:SUITE 309
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3618
Practice Address - Country:US
Practice Address - Phone:203-372-4211
Practice Address - Fax:203-372-4142
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2016-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT045060207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001450600Medicaid
CTP00414732Medicare PIN
CT001450600Medicaid
CT0400012818Medicare PIN