Provider Demographics
NPI: | 1538134648 |
---|---|
Name: | PALMER, SCOTT C (DO) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SCOTT |
Middle Name: | C |
Last Name: | PALMER |
Suffix: | |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1107 9TH AVE |
Mailing Address - Street 2: | PO BOX 50 |
Mailing Address - City: | DE WITT |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52742-1053 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 563-659-8141 |
Mailing Address - Fax: | 563-659-2121 |
Practice Address - Street 1: | 1107 9TH AVE |
Practice Address - Street 2: | |
Practice Address - City: | DE WITT |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52742-1053 |
Practice Address - Country: | US |
Practice Address - Phone: | 563-659-8141 |
Practice Address - Fax: | 563-659-2121 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-02-22 |
Last Update Date: | 2008-01-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IA | 2016 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IA | 4100271 | Medicaid | |
IA | 0467990001 | Other | MEDICARE REGION D DMERC |
IA | 3100271 | Medicaid | |
IA | 3100271 | Medicaid | |
IA | 41042 | Medicare ID - Type Unspecified | |
IA | 44822 | Medicare ID - Type Unspecified | LOWDEN OFFICE LOCATION |