Provider Demographics
NPI:1518277672
Name:SCOTT D. FISCUS
Entity Type:Organization
Organization Name:SCOTT D. FISCUS
Other - Org Name:PRECISION OCULAR PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FISCUS
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:615-361-0930
Mailing Address - Street 1:2611 WESTWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2709
Mailing Address - Country:US
Mailing Address - Phone:615-361-0930
Mailing Address - Fax:615-467-7507
Practice Address - Street 1:2611 WESTWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2709
Practice Address - Country:US
Practice Address - Phone:615-361-0930
Practice Address - Fax:615-467-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1700X
TN02-294-20335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ021236Medicaid
KY90274218Medicaid
TN7586530001Medicare NSC
TNQ021236Medicaid
KY90274218Medicaid
KY90274218Medicaid
KY90274218Medicaid