Provider Demographics
NPI:1073607917
Name:SCOTT, BEVERLY THERESE (OD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:THERESE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:BEVERLY
Other - Middle Name:THERESE
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 PARK ST
Mailing Address - Street 2:
Mailing Address - City:PEPPERELL
Mailing Address - State:MA
Mailing Address - Zip Code:01463-1106
Mailing Address - Country:US
Mailing Address - Phone:978-433-7768
Mailing Address - Fax:
Practice Address - Street 1:605 LINCOLN ST
Practice Address - Street 2:WORCESTER VETERANS ADMINISTRATION OUTPATIENT CLINIC
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-856-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist