Provider Demographics
NPI:1548407356
Name:DR. SCOTT CONROY, LLP
Entity Type:Organization
Organization Name:DR. SCOTT CONROY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:409-899-1177
Mailing Address - Street 1:5854B EASTEX FWY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-4824
Mailing Address - Country:US
Mailing Address - Phone:409-899-1177
Mailing Address - Fax:409-899-4115
Practice Address - Street 1:5854B EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-4824
Practice Address - Country:US
Practice Address - Phone:409-899-1177
Practice Address - Fax:409-899-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4244TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24FDOtherBLUE CROSS BLUE SHIELD