Provider Demographics
NPI:1396732434
Name:KAMMER, SCOTT DWAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DWAYNE
Last Name:KAMMER
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 1:25 N METZGER AVE
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-1223
Mailing Address - Country:US
Mailing Address - Phone:330-925-1926
Mailing Address - Fax:
Practice Address - Street 1:946 PEARL RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2562
Practice Address - Country:US
Practice Address - Phone:330-273-1010
Practice Address - Fax:330-225-8115
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3247T1023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T47600Medicare UPIN
OH0516953Medicare PIN
OH1158740002Medicare NSC
OH9290321Medicare PIN