Provider Demographics
NPI:1841236601
Name:SCOTT, ROBERT V (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:V
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 1:5917 SPRING POND RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845
Mailing Address - Country:US
Mailing Address - Phone:260-482-7539
Mailing Address - Fax:
Practice Address - Street 1:3812 WEST JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-734-1998
Practice Address - Fax:260-436-6455
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001728A152W00000X
IN18001728B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00309137OtherRAILROAD MEDICARE
IN1728OtherEYEMED VISION NO.
T34496Medicare UPIN