Provider Demographics
NPI:1649253352
Name:SCEARCE, GARY WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:WAYNE
Last Name:SCEARCE
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 1:449 E SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3539
Mailing Address - Country:US
Mailing Address - Phone:219-662-1600
Mailing Address - Fax:219-662-2760
Practice Address - Street 1:449 E SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3539
Practice Address - Country:US
Practice Address - Phone:219-662-1600
Practice Address - Fax:219-662-2760
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001881B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084509OtherANTHEM
IN100158610AMedicaid
IN580001508Medicare PIN
IN100158610AMedicaid
IN0135910001Medicare NSC
495570Medicare PIN
INP0010493Medicare PIN