Provider Demographics
NPI:1528218542
Name:J. SCOTT STEWART, O.D.
Entity Type:Organization
Organization Name:J. SCOTT STEWART, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-874-8164
Mailing Address - Street 1:122 W FRONT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1467
Mailing Address - Country:US
Mailing Address - Phone:419-874-8164
Mailing Address - Fax:419-874-1295
Practice Address - Street 1:122 W FRONT ST
Practice Address - Street 2:SUITE F
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1467
Practice Address - Country:US
Practice Address - Phone:419-874-8164
Practice Address - Fax:419-874-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0824620001Medicare NSC