Provider Demographics
NPI:1962649657
Name:PALADICHUK, SCOTT S (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:S
Last Name:PALADICHUK
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 1:100 HOSPITAL DR W
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1334
Mailing Address - Country:US
Mailing Address - Phone:601-268-5910
Mailing Address - Fax:601-264-0659
Practice Address - Street 1:100 HOSPITAL DR W
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1334
Practice Address - Country:US
Practice Address - Phone:601-268-5910
Practice Address - Fax:601-264-0659
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN2895152W00000X
MS829152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1160823OtherCIGNA
MS9036592OtherAETNA
MS00154827Medicaid
MS6041813OtherHEALTHSPRING