Provider Demographics
NPI:1285862227
Name:CLASS, SCOT ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:ANTHONY
Last Name:CLASS
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 1:3855 BROAD STREET
Mailing Address - Street 2:STE B
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7109
Mailing Address - Country:US
Mailing Address - Phone:805-545-8100
Mailing Address - Fax:805-548-8785
Practice Address - Street 1:3855 BROAD STREET
Practice Address - Street 2:STE B
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7109
Practice Address - Country:US
Practice Address - Phone:805-545-8100
Practice Address - Fax:805-548-8785
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT3365TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ438709Medicaid
AZZ162642Medicare PIN
AZZ162078Medicare PIN
Z130716Medicare UPIN