Provider Demographics
NPI:1912975673
Name:FINE, B. SCOTT (OD)
Entity type:Individual
Prefix:DR
First Name:B.
Middle Name:SCOTT
Last Name:FINE
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 1:381 WHITE SPRUCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1603
Mailing Address - Country:US
Mailing Address - Phone:585-424-5050
Mailing Address - Fax:585-424-1009
Practice Address - Street 1:381 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1603
Practice Address - Country:US
Practice Address - Phone:585-424-5050
Practice Address - Fax:585-424-1009
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003075152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161072528OtherTAX ID
NY00451794Medicaid
NY161072528OtherTAX ID
NYW52307Medicare UPIN