Provider Demographics
NPI:1124024906
Name:TOMASINO, SCOTT A (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:TOMASINO
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 1:302 E PITMAN ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2623
Mailing Address - Country:US
Mailing Address - Phone:636-272-1444
Mailing Address - Fax:636-272-1359
Practice Address - Street 1:302 E PITMAN ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2623
Practice Address - Country:US
Practice Address - Phone:636-272-1444
Practice Address - Fax:636-272-1359
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T42577Medicare UPIN
000091068Medicare ID - Type Unspecified