Provider Demographics
NPI:1366555229
Name:CONROY, SCOTT ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ROBERT
Last Name:CONROY
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 1:5854B EASTEX FWY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-4824
Mailing Address - Country:US
Mailing Address - Phone:409-899-1177
Mailing Address - Fax:409-899-4115
Practice Address - Street 1:5854B EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-4824
Practice Address - Country:US
Practice Address - Phone:409-899-1177
Practice Address - Fax:409-899-4115
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4244T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20563OtherSPECTERA
TX760564863OtherNVA
TX019201501Medicaid
TX55927OtherSAFEGUARD
TXVTX000755OtherAVESIS
TX24FDOtherBLUE CROSS
TX613548OtherMEDICARE PTAN/PROVIDER #
TX24FDOtherBLUE CROSS