Provider Demographics
NPI:1811931462
Name:THOMPSON, SCOTT W
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CATTARAUGUS INDIAN RESERVATION HEALTH CENTER
Mailing Address - Street 2:36 THOMAS INDIAN SCHOOL DRIVE
Mailing Address - City:IRVING
Mailing Address - State:NY
Mailing Address - Zip Code:14081
Mailing Address - Country:US
Mailing Address - Phone:716-532-5582
Mailing Address - Fax:
Practice Address - Street 1:CATTARAUGUS INDIAN RESERVATION HEALTH CENTER
Practice Address - Street 2:36 THOMAS INDIAN SCHOOL DRIVE
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081
Practice Address - Country:US
Practice Address - Phone:716-532-5582
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC005872156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician