Provider Demographics
NPI:1407842156
Name:SCOGGIN, DIANA MEADE (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MEADE
Last Name:SCOGGIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:DIANA
Other - Middle Name:LYNNE
Other - Last Name:MEADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-1887
Mailing Address - Country:US
Mailing Address - Phone:573-346-5951
Mailing Address - Fax:573-346-3252
Practice Address - Street 1:117 S BUSINESS ROUTE 5
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-1887
Practice Address - Country:US
Practice Address - Phone:573-346-5951
Practice Address - Fax:573-346-3252
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
117301OtherBCBS
MO312303605Medicaid
MOCS1078Medicare PIN
MO0201180001Medicare NSC
MO312303605Medicaid