Provider Demographics
NPI:1598792475
Name:SCOLARO, DONNA LYNNE (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNNE
Last Name:SCOLARO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BURTON DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3539
Mailing Address - Country:US
Mailing Address - Phone:707-447-2020
Mailing Address - Fax:
Practice Address - Street 1:1350 BURTON DR
Practice Address - Street 2:SUITE 250
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3539
Practice Address - Country:US
Practice Address - Phone:707-447-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9087T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU28518Medicare UPIN
CA6487300001Medicare NSC
CASD0090870Medicare PIN