Provider Demographics
NPI:1699898429
Name:SCOTT, CAMERON C (OD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:C
Last Name:SCOTT
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 1:7600 S HIGHWAY 69A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-1016
Mailing Address - Country:US
Mailing Address - Phone:918-332-4312
Mailing Address - Fax:918-332-4418
Practice Address - Street 1:7600 S HIGHWAY 69A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1016
Practice Address - Country:US
Practice Address - Phone:918-332-4312
Practice Address - Fax:918-332-4418
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1502433Medicaid
OK8HE788Medicare ID - Type UnspecifiedEL RENO MEDICARE
OKU87910Medicare UPIN
OK8HD775Medicare ID - Type UnspecifiedCLINTON MEDICARE
OK1502433Medicaid