Provider Demographics
NPI:1689609505
Name:SCOTT, MARY K (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:K
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1215
Mailing Address - Country:US
Mailing Address - Phone:508-481-5500
Mailing Address - Fax:
Practice Address - Street 1:24 NEWTON ST
Practice Address - Street 2:
Practice Address - City:SOUTHBORO
Practice Address - State:MA
Practice Address - Zip Code:01772
Practice Address - Country:US
Practice Address - Phone:508-460-3150
Practice Address - Fax:508-460-3061
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2230152W00000X
RI00331152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0354007Medicaid
763274OtherTUFTS
763274OtherTUFTS
763274OtherTUFTS