Provider Demographics
NPI:1861471427
Name:SATHER, SCOTT K (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
Last Name:SATHER
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 1:622 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3520
Mailing Address - Country:US
Mailing Address - Phone:906-226-8800
Mailing Address - Fax:906-226-8802
Practice Address - Street 1:622 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3520
Practice Address - Country:US
Practice Address - Phone:906-226-8800
Practice Address - Fax:906-226-8802
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3179850Medicaid
MIMOE2650OtherBCBS OF MI
MI410027840OtherPALMETTO MEDICARE
MIOM12110Medicare ID - Type Unspecified
MION88840Medicare PIN
MI3179850Medicaid