Provider Demographics
NPI:1295055143
Name:KURITA, SCOTT ROBERT (OD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ROBERT
Last Name:KURITA
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 1:947 SE MILLER STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:817-657-0264
Mailing Address - Fax:
Practice Address - Street 1:1804 SE ENSIGN LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-7339
Practice Address - Country:US
Practice Address - Phone:503-338-4114
Practice Address - Fax:503-338-4115
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3362ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist