Provider Demographics
NPI:1275510307
Name:HAGE, SCOTT F (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:F
Last Name:HAGE
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 1:240 RIVERSIDE DR
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2732
Mailing Address - Country:US
Mailing Address - Phone:607-729-2102
Mailing Address - Fax:607-729-2034
Practice Address - Street 1:240 RIVERSIDE DR
Practice Address - Street 2:SUITE ONE
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2732
Practice Address - Country:US
Practice Address - Phone:607-729-2102
Practice Address - Fax:607-729-2034
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0044181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT86364Medicare UPIN
NY51484BMedicare PIN
NY0295290001OtherDME