Provider Demographics
NPI:1578548251
Name:BRIZIUS, SCOTT R (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:BRIZIUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1628
Mailing Address - Country:US
Mailing Address - Phone:812-477-8696
Mailing Address - Fax:812-477-1874
Practice Address - Street 1:2700 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1628
Practice Address - Country:US
Practice Address - Phone:812-477-8696
Practice Address - Fax:812-477-1874
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ1919152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1919OtherSTATE LICENSE NUMBER
IN100320150AMedicaid
IN0131080001Medicare NSC
INM400019215Medicare PIN
IN100320150AMedicaid