Provider Demographics
NPI:1942394937
Name:POTTER, SCOTT ELLIS I (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ELLIS
Last Name:POTTER
Suffix:I
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 1:3509 NW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1157
Mailing Address - Country:US
Mailing Address - Phone:816-436-4786
Mailing Address - Fax:
Practice Address - Street 1:19 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2728
Practice Address - Country:US
Practice Address - Phone:816-468-4680
Practice Address - Fax:816-468-6444
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO-T-2750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist