Provider Demographics
NPI:1205991130
Name:HASTY, SCOTT K (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:K
Last Name:HASTY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:804 BROAD RIPPLE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1961
Practice Address - Country:US
Practice Address - Phone:317-254-6480
Practice Address - Fax:317-259-8906
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN18003114152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0873400001Medicare NSC
IN85660Medicare UPIN
IN894060HMedicare PIN