Provider Demographics
NPI:1851338933
Name:EARLE, SCOTT RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RICHARD
Last Name:EARLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:488 FREEDOM PLAINS RD
Mailing Address - Street 2:BOX 1
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2689
Mailing Address - Country:US
Mailing Address - Phone:845-592-0123
Mailing Address - Fax:845-471-7531
Practice Address - Street 1:488 FREEDOM PLAINS RD
Practice Address - Street 2:SUITE 137
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2689
Practice Address - Country:US
Practice Address - Phone:845-471-7400
Practice Address - Fax:845-471-7531
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006869152WC0802X
ALS-971-TA-533152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL81879Medicare UPIN