Provider Demographics
NPI:1538685086
Name:SCAVO OPTOMETRIC GROUP, INC.
Entity Type:Organization
Organization Name:SCAVO OPTOMETRIC GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICKOLAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SCAVO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-624-4042
Mailing Address - Street 1:24673 LAS PATRANAS
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-5114
Mailing Address - Country:US
Mailing Address - Phone:714-624-4042
Mailing Address - Fax:714-692-5716
Practice Address - Street 1:21540 HAWTHORNE BLVD. , # 539
Practice Address - Street 2:LENSCRAFTERS - DEL AMO FASHION CENTER
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5707
Practice Address - Country:US
Practice Address - Phone:301-370-0016
Practice Address - Fax:310-370-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty