Provider Demographics
NPI:1255432274
Name:DENISON, SCOTT M (OD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:DENISON
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 1:100 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3834
Mailing Address - Country:US
Mailing Address - Phone:812-288-7179
Mailing Address - Fax:812-282-0203
Practice Address - Street 1:100 E 12TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3834
Practice Address - Country:US
Practice Address - Phone:812-288-7179
Practice Address - Fax:812-282-0203
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001727B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist