Provider Demographics
NPI:1821093741
Name:SCAMAN, RONALD LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:SCAMAN
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:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-0737
Mailing Address - Country:US
Mailing Address - Phone:360-642-2710
Mailing Address - Fax:
Practice Address - Street 1:101 11TH ST NW
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-0737
Practice Address - Country:US
Practice Address - Phone:360-642-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001108152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006609Medicaid
WA2006609Medicaid
WAG000800076Medicare PIN