Provider Demographics
NPI:1710063417
Name:MCDOUGAL, SCOTT ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANDREW
Last Name:MCDOUGAL
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 1:1749 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5903
Mailing Address - Country:US
Mailing Address - Phone:573-335-3937
Mailing Address - Fax:573-334-5271
Practice Address - Street 1:1749 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5903
Practice Address - Country:US
Practice Address - Phone:573-335-3937
Practice Address - Fax:573-334-5271
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001016028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U85287Medicare UPIN