Provider Demographics
NPI:1528104841
Name:SCAROZZA, GUY R (OD)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:R
Last Name:SCAROZZA
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 1:3974 KARL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-5221
Mailing Address - Country:US
Mailing Address - Phone:614-267-7633
Mailing Address - Fax:614-267-0534
Practice Address - Street 1:3974 KARL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-5221
Practice Address - Country:US
Practice Address - Phone:614-267-7633
Practice Address - Fax:614-267-0534
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4490T1146152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0984083Medicaid
OHSCO768177Medicare ID - Type Unspecified
OHU52840Medicare UPIN