Scott Eric Olitsky, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

2002023847 Issued in MO

Practice address

25162 Armagosa Dr
Laguna Niguel, CA 92677

Phone

(913) 908-0059

Fax

(681) 231-6256

NPI assigned

Jun 5, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1013956085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12641 ANTIOCH RD # 1197",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662131701",
            "telephone_number": "913-908-0059",
            "fax_number": "681-231-6256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25162 ARMAGOSA DR",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "92677",
            "telephone_number": "913-908-0059",
            "fax_number": "681-231-6256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLITSKY",
        "first_name": "SCOTT",
        "middle_name": "ERIC",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "KS",
            "license": "04-29858",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "2002023847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205919202",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Laguna Niguel, CA
• Providers in Laguna Niguel, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.