Provider Demographics
NPI:1578637310
Name:GORMAN, N SCOTT
Entity Type:Individual
Prefix:
First Name:N
Middle Name:SCOTT
Last Name:GORMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 NE 190TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3175
Mailing Address - Country:US
Mailing Address - Phone:954-806-8446
Mailing Address - Fax:866-382-7695
Practice Address - Street 1:1825 NE 164TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4100
Practice Address - Country:US
Practice Address - Phone:305-945-7113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084468300Medicaid
FLT84017Medicare UPIN