Provider Demographics
NPI:1376842559
Name:SCOTT, PATRICK JASON (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JASON
Last Name:SCOTT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1360 E HERNDON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3326
Mailing Address - Country:US
Mailing Address - Phone:559-449-5050
Mailing Address - Fax:559-432-2632
Practice Address - Street 1:1360 E HERNDON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3326
Practice Address - Country:US
Practice Address - Phone:559-449-5050
Practice Address - Fax:559-432-2632
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1376842559Medicare NSC