Provider Demographics
NPI:1942315676
Name:PAGE, SCOTT M (OD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:M
Last Name:PAGE
Suffix:
Gender:M
Credentials:OD
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Other - First Name:
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Mailing Address - Street 1:1015 CHESTNUT STREET
Mailing Address - Street 2:SUITE 417
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4316
Mailing Address - Country:US
Mailing Address - Phone:215-627-4448
Mailing Address - Fax:215-627-5798
Practice Address - Street 1:1015 CHESTNUT STREET
Practice Address - Street 2:SUITE 417
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19107-4316
Practice Address - Country:US
Practice Address - Phone:215-627-4448
Practice Address - Fax:215-627-5798
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG001654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0062224000OtherBC BS
PA30037OtherAETNA
PA0736650001Medicaid
PA0062224000OtherBC BS
PA0736650001Medicaid