Provider Demographics
NPI:1518454560
Name:HEBERT, SCOTT LEO (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LEO
Last Name:HEBERT
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2316
Mailing Address - Country:US
Mailing Address - Phone:585-276-8608
Mailing Address - Fax:585-671-2540
Practice Address - Street 1:603 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2316
Practice Address - Country:US
Practice Address - Phone:585-276-8608
Practice Address - Fax:585-671-2540
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005906156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician