Provider Demographics
NPI:1831226406
Name:DALY, SCOTT P (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:P
Last Name:DALY
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 1:904 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3802
Mailing Address - Country:US
Mailing Address - Phone:831-426-1050
Mailing Address - Fax:831-423-1050
Practice Address - Street 1:904 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3802
Practice Address - Country:US
Practice Address - Phone:831-426-1050
Practice Address - Fax:831-423-1050
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10598Medicare UPIN
CAYYY49785YMedicare ID - Type Unspecified
CAZZZ27600ZMedicare ID - Type Unspecified