Provider Demographics
NPI:1669695532
Name:SCOTT P DALY SANTA CRUZ OPTOMETRIC
Entity type:Organization
Organization Name:SCOTT P DALY SANTA CRUZ OPTOMETRIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:831-426-1050
Mailing Address - Street 1:904 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3802
Mailing Address - Country:US
Mailing Address - Phone:831-426-1050
Mailing Address - Fax:831-423-1050
Practice Address - Street 1:904 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3802
Practice Address - Country:US
Practice Address - Phone:831-426-1050
Practice Address - Fax:831-423-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0077851OtherINDIVIDUAL PTAN
CASD0077851OtherINDIVIDUAL PTAN
CAZZZ27600ZMedicare ID - Type Unspecified
CAYYY49785YMedicare ID - Type Unspecified