Provider Demographics
NPI:1306837026
Name:WILLEFORD, SCOTT K (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
Last Name:WILLEFORD
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 1:150 SE 17TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5178
Mailing Address - Country:US
Mailing Address - Phone:352-732-7900
Mailing Address - Fax:352-732-7466
Practice Address - Street 1:150 SE 17TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5178
Practice Address - Country:US
Practice Address - Phone:352-732-7900
Practice Address - Fax:352-732-7466
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620409100Medicaid
FL620409100Medicaid
FL20819Medicare ID - Type UnspecifiedINDIVIDUAL