Provider Demographics
NPI:1932105467
Name:SCOTT, MATTHEW L (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:L
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:PO BOX 3179
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-3179
Mailing Address - Country:US
Mailing Address - Phone:719-581-4060
Mailing Address - Fax:719-631-2577
Practice Address - Street 1:421 HWY 24 S
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-3179
Practice Address - Country:US
Practice Address - Phone:719-581-4060
Practice Address - Fax:719-631-2577
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2374152W00000X
KS1630152W00000X
CO0003040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100847010AMedicaid
OK410049616OtherRR MEDICARE
CO21634378Medicaid
OK4706790001OtherDMERC
OKP00278572OtherRAILROAD MEDICARE
OK4706790001OtherDMERC
OK410049616OtherRR MEDICARE
CO21634378Medicaid
OK4706790001Medicare NSC
COU91507Medicare UPIN