Provider Demographics
NPI:1649212895
Name:CALVIN, W SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:W SCOTT
Middle Name:
Last Name:CALVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8833 RESEDA BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4043
Mailing Address - Country:US
Mailing Address - Phone:818-727-2626
Mailing Address - Fax:818-727-2625
Practice Address - Street 1:8833 RESEDA BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4043
Practice Address - Country:US
Practice Address - Phone:818-727-2626
Practice Address - Fax:818-727-2625
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG070410207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70410Medicare PIN
CAF42629Medicare UPIN