Provider Demographics
NPI:1932349958
Name:SCOTT, SUNNI HOUSTON (OD)
Entity type:Individual
Prefix:DR
First Name:SUNNI
Middle Name:HOUSTON
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUNNI
Other - Middle Name:
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:419 W. REDWOOD STREET
Mailing Address - Street 2:SUITE 470
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-328-3947
Mailing Address - Fax:410-328-1178
Practice Address - Street 1:419 W. REDWOOD STREET
Practice Address - Street 2:SUITE 420
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-328-6533
Practice Address - Fax:410-328-6503
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2101152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No152W00000XEye and Vision Services ProvidersOptometrist