Provider Demographics
NPI:1609989995
Name:SANZOTTA, SCOTT ELIOT (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ELIOT
Last Name:SANZOTTA
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:CMR 467 BOX 3521
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096
Mailing Address - Country:DE
Mailing Address - Phone:01149-200-9826
Mailing Address - Fax:
Practice Address - Street 1:MAINZ KASTEL OPTOMETRY CLINIC
Practice Address - Street 2:UNIT 29645
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09096
Practice Address - Country:DE
Practice Address - Phone:01149613-420-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4229152W00000X
GU35152W00000X
CO1659152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUU77938Medicare UPIN