Provider Demographics
NPI:1639254287
Name:SCOTT, HARRY E (OD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:E
Last Name:SCOTT
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 1:2910 MARKET LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1855
Mailing Address - Country:US
Mailing Address - Phone:254-778-6165
Mailing Address - Fax:254-778-5257
Practice Address - Street 1:2910 MARKET LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1855
Practice Address - Country:US
Practice Address - Phone:254-778-6165
Practice Address - Fax:254-778-5257
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1917TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15804Medicare UPIN
TX80187EMedicare ID - Type UnspecifiedMEDICARE