Provider Demographics
NPI:1316922446
Name:OLIVER, SCOTT C (OD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:OLIVER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2935
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-4935
Mailing Address - Country:US
Mailing Address - Phone:803-327-1181
Mailing Address - Fax:803-327-9650
Practice Address - Street 1:406 N WILSON ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4050
Practice Address - Country:US
Practice Address - Phone:803-327-1181
Practice Address - Fax:803-327-9650
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC937152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD09373Medicaid
SCP00609684OtherRAILROAD MEDICARE
SCD09373Medicaid
SCT97459Medicare UPIN
SCT974598687Medicare PIN