Provider Demographics
NPI:1942217641
Name:HORA, SCOTT LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LEE
Last Name:HORA
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 1:8300 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-8636
Mailing Address - Country:US
Mailing Address - Phone:937-833-5944
Mailing Address - Fax:
Practice Address - Street 1:430 ARLINGTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-1103
Practice Address - Country:US
Practice Address - Phone:937-770-1265
Practice Address - Fax:937-770-1268
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4119452OtherMEDICARE PTAN
OHU97331Medicare UPIN