Provider Demographics
NPI:1811344971
Name:DR SCOTT E GITTINS OD & DR JOHN COEN OD INC
Entity type:Organization
Organization Name:DR SCOTT E GITTINS OD & DR JOHN COEN OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:GITTINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-624-2020
Mailing Address - Street 1:6809 FIVE STAR BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2687
Mailing Address - Country:US
Mailing Address - Phone:916-624-2020
Mailing Address - Fax:916-624-3027
Practice Address - Street 1:6809 FIVE STAR BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2687
Practice Address - Country:US
Practice Address - Phone:916-624-2020
Practice Address - Fax:916-624-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9752TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30715ZMedicare PIN