Provider Demographics
NPI:1407988694
Name:SCOTT A. GARTNER, OD, PA
Entity Type:Organization
Organization Name:SCOTT A. GARTNER, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-557-5913
Mailing Address - Street 1:5944 CORAL RIDGE DR
Mailing Address - Street 2:#210
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3300
Mailing Address - Country:US
Mailing Address - Phone:954-557-5913
Mailing Address - Fax:
Practice Address - Street 1:1710 TIFFANY DR E
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3242
Practice Address - Country:US
Practice Address - Phone:561-586-5600
Practice Address - Fax:866-425-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1411152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620469400Medicaid
FL39405BMedicare PIN
FL39405CMedicare PIN
FL39405AMedicare PIN
FL19834FMedicare PIN
FL19834DMedicare PIN
FL620469400Medicaid