Provider Demographics
NPI:1235122169
Name:PRICKETT, SCOTT R (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:PRICKETT
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 1:44 BARKLEY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7530
Mailing Address - Country:US
Mailing Address - Phone:399-857-1712
Mailing Address - Fax:239-985-7118
Practice Address - Street 1:5335 AIRPORT PULLING RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2011
Practice Address - Country:US
Practice Address - Phone:239-594-5550
Practice Address - Fax:239-592-5744
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP002554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250273900Medicaid
FLP4949OtherPTAN
FL250273900Medicaid