Provider Demographics
NPI:1346767027
Name:AMORUSO, SCOTT MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MICHAEL
Last Name:AMORUSO
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 1:4835 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3532
Mailing Address - Country:US
Mailing Address - Phone:708-359-9909
Mailing Address - Fax:
Practice Address - Street 1:2000 N CLYBOURN AVE # G2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4056
Practice Address - Country:US
Practice Address - Phone:773-975-7867
Practice Address - Fax:773-975-1972
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist