Provider Demographics
NPI:1346343928
Name:FISCUS, SCOTT D (BCO)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:D
Last Name:FISCUS
Suffix:
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 WESTWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2709
Mailing Address - Country:US
Mailing Address - Phone:615-361-0930
Mailing Address - Fax:615-467-7507
Practice Address - Street 1:2611 WESTWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2709
Practice Address - Country:US
Practice Address - Phone:615-361-0930
Practice Address - Fax:615-467-7507
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN02294-14156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225270001Medicare ID - Type Unspecified