Provider Demographics
NPI:1417958059
Name:SCOTT, LANCE V (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:V
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9821 S MAY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7042
Mailing Address - Country:US
Mailing Address - Phone:405-691-0505
Mailing Address - Fax:405-691-0507
Practice Address - Street 1:9821 S MAY AVE STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7042
Practice Address - Country:US
Practice Address - Phone:405-691-0505
Practice Address - Fax:405-691-0507
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2021-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK27666207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102801Medicaid
OK200315040AMedicaid
ILK50465Medicare PIN