Provider Demographics
NPI:1326120338
Name:SCOTT, SUZANNE DENISE (OD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:DENISE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 N GRAND AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3472
Mailing Address - Country:US
Mailing Address - Phone:509-334-3610
Mailing Address - Fax:509-334-1462
Practice Address - Street 1:1045 N GRAND AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-3472
Practice Address - Country:US
Practice Address - Phone:509-334-3610
Practice Address - Fax:509-334-1462
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2033090Medicaid
WAU53545Medicare UPIN
WAGAB26666Medicare PIN