Provider Demographics
NPI:1740281104
Name:GONTAREK, SCOTT E (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:GONTAREK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:501 BATTLEFIELD BLVD N
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4947
Mailing Address - Country:US
Mailing Address - Phone:757-966-2066
Mailing Address - Fax:757-966-2743
Practice Address - Street 1:501 BATTLEFIELD BLVD N
Practice Address - Street 2:SUITE B
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4947
Practice Address - Country:US
Practice Address - Phone:757-966-2066
Practice Address - Fax:757-966-2743
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA386492OtherANTHEM
VAU72582Medicare UPIN
VA386492OtherANTHEM