Provider Demographics
NPI:1033166459
Name:ECCARIUS, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:ECCARIUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 SAINT ANNE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4678
Mailing Address - Country:US
Mailing Address - Phone:605-343-4120
Mailing Address - Fax:
Practice Address - Street 1:631 SAINT ANNE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4678
Practice Address - Country:US
Practice Address - Phone:605-343-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD3450207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S2468OtherMEDICARE PTAN
SD6300422Medicaid
SDE87040Medicare UPIN