Provider Demographics
NPI:1790879872
Name:SCADUTO, SAMUEL E (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:E
Last Name:SCADUTO
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 1:3768 SENECA STREET
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-674-8300
Mailing Address - Fax:716-674-8302
Practice Address - Street 1:3768 SENECA STREET
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-674-8300
Practice Address - Fax:716-674-8302
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY4079OtherEYE MED
NYU0390005002OtherCB
NYRA6080Medicare PIN
NYNY4079OtherEYE MED
NYU0390005002OtherCB