Provider Demographics
NPI:1922002989
Name:DRIESEN, SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:DRIESEN
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 20
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-0020
Mailing Address - Country:US
Mailing Address - Phone:712-722-2051
Mailing Address - Fax:712-722-4531
Practice Address - Street 1:318 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-0020
Practice Address - Country:US
Practice Address - Phone:712-722-2051
Practice Address - Fax:712-722-4531
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0121020Medicaid
IA44794OtherWELLMARK
IA410040458OtherRAILROAD MEDICARE
SD9200512Medicaid
IAMD0024808OtherDEA
SD9200512Medicaid
IA410040458OtherRAILROAD MEDICARE
IAU54327Medicare UPIN
IAMD0024808OtherDEA