Provider Demographics
NPI:1023265642
Name:SCOTT P DALY SANTA CRUZ OPTOMETRIC
Entity type:Organization
Organization Name:SCOTT P DALY SANTA CRUZ OPTOMETRIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-426-1050
Mailing Address - Street 1:904 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3802
Mailing Address - Country:US
Mailing Address - Phone:831-426-1050
Mailing Address - Fax:831-423-1050
Practice Address - Street 1:3275 APTOS RANCHO RD
Practice Address - Street 2:SUITE B
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3983
Practice Address - Country:US
Practice Address - Phone:831-685-1050
Practice Address - Fax:831-685-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27600ZOtherPTAN
CASD0077852OtherINDIVIDUAL PTAN