Provider Demographics
NPI:1134479835
Name:SCOTT, AMANDA MORRIS (OD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MORRIS
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S UNIVERSITY DR
Mailing Address - Street 2:TERRY BUILDING SUITE 1402
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2018
Mailing Address - Country:US
Mailing Address - Phone:954-262-1402
Mailing Address - Fax:954-262-3217
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:ZIFF BUILDING 2ND FLOOR
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-1402
Practice Address - Fax:954-262-3217
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist