Provider Demographics
NPI:1942254917
Name:SCOTT, BERNARD H (OD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:H
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 1:27900 N MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7077
Mailing Address - Country:US
Mailing Address - Phone:251-621-1211
Mailing Address - Fax:251-621-9052
Practice Address - Street 1:27900 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7077
Practice Address - Country:US
Practice Address - Phone:251-621-1211
Practice Address - Fax:251-621-9052
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5330TA122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000026434Medicaid
1290420001OtherPALMETTO GBA
051026434OtherBCBS
T69057Medicare UPIN
051026434OtherBCBS