Provider Demographics
NPI:1376644906
Name:PHILIPPE, SCOTT LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LOUIS
Last Name:PHILIPPE
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 1:8811 BLAKENEY PROFESSIONAL DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6599
Mailing Address - Country:US
Mailing Address - Phone:704-926-3937
Mailing Address - Fax:704-926-3938
Practice Address - Street 1:8811 BLAKENEY PROFESSIONAL DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6599
Practice Address - Country:US
Practice Address - Phone:704-926-3937
Practice Address - Fax:704-926-3938
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890955AMedicaid
4105310OtherMAMSI
5131920001OtherMEDICARE NFC
E1350OtherMEDCOST
0955AOtherBC/BS NC
5140170OtherAETNA
NC2467153Medicare ID - Type Unspecified
NC890955AMedicaid
0955AOtherBC/BS NC