Provider Demographics
NPI:1497823819
Name:PROPSOM, SCOTT STEVEN (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:STEVEN
Last Name:PROPSOM
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 1:4021 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-5439
Mailing Address - Country:US
Mailing Address - Phone:515-720-9668
Mailing Address - Fax:
Practice Address - Street 1:4021 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-5439
Practice Address - Country:US
Practice Address - Phone:515-720-9668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02273152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0426221Medicaid
IA0426221Medicaid
IAI11741Medicare ID - Type Unspecified