Provider Demographics
NPI:1457316259
Name:SYLVIA, SCOTT WAYNE (OD/MBA)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WAYNE
Last Name:SYLVIA
Suffix:
Gender:M
Credentials:OD/MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PORTER SQ
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1431
Mailing Address - Country:US
Mailing Address - Phone:617-864-5094
Mailing Address - Fax:617-864-3250
Practice Address - Street 1:1 PORTER SQ
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1431
Practice Address - Country:US
Practice Address - Phone:617-864-5094
Practice Address - Fax:617-864-3250
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA003306152W00000X
RI407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW16106OtherBLUE CROSS
MA153430OtherHARVARD PILGRIM HEALTH
MA003306OtherTUFTS HEALTH PLAN
MA153430OtherHARVARD PILGRIM HEALTH
MAW17255Medicare PIN