Provider Demographics
NPI:1245255769
Name:KLASMAN, SCOTT (OD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:KLASMAN
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 1:9673 GWYNN PARK DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5718
Mailing Address - Country:US
Mailing Address - Phone:410-480-8178
Mailing Address - Fax:
Practice Address - Street 1:13830 OUTLET DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4970
Practice Address - Country:US
Practice Address - Phone:301-890-9779
Practice Address - Fax:301-890-0923
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1176152W00000X
PAOET008917152W00000X
VA0618001378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD922117Medicaid
MDG01711E01Medicare ID - Type Unspecified
MDU58700Medicare UPIN