Provider Demographics
NPI:1114911666
Name:SCOTT, ALAN D (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:SCOTT
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 1:605 N MCEWAN ST
Mailing Address - Street 2:P.O. BOX 60
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-1439
Mailing Address - Country:US
Mailing Address - Phone:989-386-2111
Mailing Address - Fax:989-386-2180
Practice Address - Street 1:605 N MCEWAN ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1439
Practice Address - Country:US
Practice Address - Phone:989-386-2111
Practice Address - Fax:989-386-2180
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS002506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI90 A 86503OtherBLUE CROSS BLUE SHIELD
MI945053099Medicaid
MIT32686Medicare UPIN
MI945053099Medicaid