Provider Demographics
NPI:1639331358
Name:STORCK, SCOTT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:STORCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1371
Mailing Address - Country:US
Mailing Address - Phone:937-324-3937
Mailing Address - Fax:937-324-8943
Practice Address - Street 1:2330 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1371
Practice Address - Country:US
Practice Address - Phone:937-324-3937
Practice Address - Fax:937-324-8943
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.095337207W00000X
IN11013273A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1639331358OtherNATIONAL NPI NUMBER
OH9911559OtherAETNA
OH3082499Medicaid
4293182Medicare PIN