Provider Demographics
NPI:1255472916
Name:BAYLARD, SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:BAYLARD
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 1:2320 ATLANTA HIGHWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:678-965-5558
Mailing Address - Fax:678-965-5502
Practice Address - Street 1:2320 ATLANTA HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6339
Practice Address - Country:US
Practice Address - Phone:678-965-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV07284Medicare UPIN