Provider Demographics
NPI:1528048618
Name:UNGER, SCOTT A (OD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:UNGER
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 1:2705 S BERKLEY RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-8025
Mailing Address - Country:US
Mailing Address - Phone:765-453-2200
Mailing Address - Fax:765-453-1768
Practice Address - Street 1:2705 S BERKLEY RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902
Practice Address - Country:US
Practice Address - Phone:765-453-2200
Practice Address - Fax:765-453-1768
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003395A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200818490Medicaid
OH2517619Medicaid
IN200818490Medicaid
OH4148561Medicare PIN
INP00401544Medicare PIN
INP00887484Medicare PIN
INP00887860Medicare PIN
OH4148562Medicare PIN
IN452570008Medicare PIN
IN186700CMedicare PIN
OH2517619Medicaid
V02653Medicare UPIN
IN222860DMedicare PIN
OH4148563Medicare PIN