Provider Demographics
NPI:1801169586
Name:SCOTT D. CLOUGH, OD , PA
Entity type:Organization
Organization Name:SCOTT D. CLOUGH, OD , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-255-2039
Mailing Address - Street 1:13837 KING AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-1329
Mailing Address - Country:US
Mailing Address - Phone:727-255-2039
Mailing Address - Fax:727-868-0819
Practice Address - Street 1:10041 US HIGHWAY 19 STE A
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3785
Practice Address - Country:US
Practice Address - Phone:727-859-9009
Practice Address - Fax:727-868-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001528000Medicaid
FLU25718Medicare UPIN