Provider Demographics
NPI:1659925816
Name:SCOTT, SAMUEL SAWYER (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SAWYER
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 1:305 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-2146
Mailing Address - Country:US
Mailing Address - Phone:662-562-6446
Mailing Address - Fax:
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2146
Practice Address - Country:US
Practice Address - Phone:662-562-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist