Provider Demographics
NPI:1699793778
Name:SCOLLIN, DAVID B (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:SCOLLIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1165 S DORA ST STE B1
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-6353
Mailing Address - Country:US
Mailing Address - Phone:707-462-0581
Mailing Address - Fax:747-463-0814
Practice Address - Street 1:1165 S DORA ST STE B1
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6353
Practice Address - Country:US
Practice Address - Phone:707-462-0581
Practice Address - Fax:707-463-0814
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASD0073400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU25403Medicare UPIN