Provider Demographics
NPI:1093925158
Name:HOLCOMB, SCOTT BUSEY (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BUSEY
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:277 BEDFORD ST SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1602
Mailing Address - Country:US
Mailing Address - Phone:770-426-9965
Mailing Address - Fax:770-590-8135
Practice Address - Street 1:3625 DALLAS HWY SW
Practice Address - Street 2:STE 660
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5912
Practice Address - Country:US
Practice Address - Phone:770-590-8951
Practice Address - Fax:770-590-8135
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU65646Medicare UPIN
GA41ZCDDBMedicare ID - Type UnspecifiedMEDICARE