Provider Demographics
NPI:1770753576
Name:SCOTT F HAGE OD
Entity type:Organization
Organization Name:SCOTT F HAGE OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:607-729-2102
Mailing Address - Street 1:240 RIVERSIDE DR
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2732
Mailing Address - Country:US
Mailing Address - Phone:607-729-2102
Mailing Address - Fax:607-729-2034
Practice Address - Street 1:240 RIVERSIDE DR
Practice Address - Street 2:SUITE ONE
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2732
Practice Address - Country:US
Practice Address - Phone:607-729-2102
Practice Address - Fax:607-729-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0044181332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0295290001Medicare NSC