Provider Demographics
NPI:1184611295
Name:SCOTT, ELAINE R (OD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
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 1:3945 S VILLAGE ROW
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-9468
Mailing Address - Country:US
Mailing Address - Phone:317-861-0060
Mailing Address - Fax:
Practice Address - Street 1:1451 JASON RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1039
Practice Address - Country:US
Practice Address - Phone:317-462-6601
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001917A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000175429OtherANTHEM
IN000000175429OtherANTHEM
INT86617Medicare UPIN