Provider Demographics
NPI:1770621088
Name:SCOTT, NICOLETTE E (OD)
Entity type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:E
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 W ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2407
Mailing Address - Country:US
Mailing Address - Phone:440-526-7070
Mailing Address - Fax:440-526-6330
Practice Address - Street 1:1261 W ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2407
Practice Address - Country:US
Practice Address - Phone:440-526-7070
Practice Address - Fax:440-526-6330
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH5247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3765222OtherAETNA (RP)
OH37666535OtherAETNA (SL)
OH000000360728OtherANTHEM (RP)
OH000000360729OtherANTHEM (SL)
OH3765222OtherAETNA (RP)