Provider Demographics
NPI:1770749160
Name:ACKERMAN, SCOTT MICHAEL (OD)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:ACKERMAN
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 1:802 N CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6342
Mailing Address - Country:US
Mailing Address - Phone:620-275-5375
Mailing Address - Fax:
Practice Address - Street 1:2508 CASEYS DR
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-3314
Practice Address - Country:US
Practice Address - Phone:620-275-5375
Practice Address - Fax:620-275-2036
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1799152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist