Provider Demographics
NPI:1346298270
Name:FURGERSON, SCOTT A (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:FURGERSON
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 1:94 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-1229
Mailing Address - Country:US
Mailing Address - Phone:614-879-7239
Mailing Address - Fax:614-879-1001
Practice Address - Street 1:94 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1229
Practice Address - Country:US
Practice Address - Phone:614-879-7239
Practice Address - Fax:614-879-1001
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2436322Medicaid
OH2436322Medicaid
OH4112151Medicare PIN