Provider Demographics
NPI:1588659593
Name:BARTON, SCOTT W (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:BARTON
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:PO BOX 26010
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-6010
Mailing Address - Country:US
Mailing Address - Phone:586-296-7250
Mailing Address - Fax:586-296-0276
Practice Address - Street 1:1000 PINE GRV
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3733
Practice Address - Country:US
Practice Address - Phone:810-982-3200
Practice Address - Fax:810-982-4480
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013776207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5188723Medicaid
MI5188714Medicaid
MI5188723Medicaid
H62040Medicare UPIN
MI5188714Medicaid
MIP00406966Medicare PIN