Provider Demographics
NPI:1013907773
Name:MORRIS, SCOT B (OD)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:B
Last Name:MORRIS
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 1:27122 MAIN ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-8559
Mailing Address - Country:US
Mailing Address - Phone:303-838-9165
Mailing Address - Fax:303-816-7218
Practice Address - Street 1:27122 MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-8559
Practice Address - Country:US
Practice Address - Phone:303-838-9165
Practice Address - Fax:303-816-7218
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2252152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33852758Medicaid
COU62055Medicare UPIN
CO2601585Medicare ID - Type Unspecified
COC544598Medicare PIN