Provider Demographics
NPI:1841290152
Name:SCOTT, GINA R (OD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:R
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 MEMORIAL PKWY SW STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6901
Mailing Address - Country:US
Mailing Address - Phone:256-533-0315
Mailing Address - Fax:
Practice Address - Street 1:3501 MEMORIAL PKWY SW STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6901
Practice Address - Country:US
Practice Address - Phone:256-533-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS823TA158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051500371OtherBCBS
AL528800620Medicaid
ALS823TA158OtherALABAMA LICENSE NUMBER
AL009947850Medicaid
ALS823TA158OtherALABAMA LICENSE NUMBER
AL528800620Medicaid