Provider Demographics
NPI:1013956085
Name:OLITSKY, SCOTT ERIC (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ERIC
Last Name:OLITSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12641 ANTIOCH RD # 1197
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1701
Mailing Address - Country:US
Mailing Address - Phone:913-908-0059
Mailing Address - Fax:681-231-6256
Practice Address - Street 1:25162 ARMAGOSA DR
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:913-908-0059
Practice Address - Fax:681-231-6256
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29858207W00000X
MO2002023847207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205919202Medicaid
F58088Medicare UPIN