Provider Demographics
NPI:1467616383
Name:COLLINGS, SCOTT (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:COLLINGS
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 1:619 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1942
Mailing Address - Country:US
Mailing Address - Phone:414-501-0416
Mailing Address - Fax:641-236-0754
Practice Address - Street 1:619 6TH AVE
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1942
Practice Address - Country:US
Practice Address - Phone:641-450-1041
Practice Address - Fax:641-236-0754
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA002426OtherLICENSE NUMBER