Provider Demographics
NPI:1174635122
Name:FELDMAN, SCOTT P (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:P
Last Name:FELDMAN
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 1:100 W SAN FERNANDO ST STE 113
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95113-2256
Mailing Address - Country:US
Mailing Address - Phone:408-294-1842
Mailing Address - Fax:
Practice Address - Street 1:100 W SAN FERNANDO ST.
Practice Address - Street 2:SUITE 113
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-2217
Practice Address - Country:US
Practice Address - Phone:408-294-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7947152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12300OtherMESC
CA20-0891341OtherLOCAL104
CA20-0891341OtherVSP
CA45179OtherSAFEGUARD
CA20-0891341OtherAETNA
CA20-0891341OtherDMERC
CA20-0891341OtherNDC
CACA7947OtherEYEMED
CA20-0891341OtherBLUESHIELD
CA20-0891341OtherRETA
20-0891341OtherBLUECROSS
CA20-0891341OtherMCSUPPLY
CA7947OtherSCFHPLAN
CASD0079471Medicare ID - Type Unspecified