Active NPI
Scott Lake, OD
- Optometrist
- Glendale, AZ
National Provider Identifier
1154587822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2519
- Practice address
- 5707 W Northern Ave Ste 106
Glendale, AZ 85301-1355 - Phone
- (602) 512-3299
- NPI assigned
- Aug 1, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 002756 | CT | |
| Optometrist | 152W00000X | 2519 | AZ | Primary |
Addresses
Primary practice location
5707 W Northern Ave Ste 106
Glendale, AZ 85301-1355
Mailing address
220 N McKemy Ave
Chandler, AZ 85226-2651
Phone (480) 961-1865
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2519 | AZ | MD | Optometrist |
| 002756 | CT | MD | Optometrist |
Interoperability endpoints
- dr.scott.lake@direct.eyecare-partners.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632182400000",
"number": "1154587822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 N MCKEMY AVE",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852262651",
"telephone_number": "480-961-1865",
"fax_number": "480-961-0794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5707 W NORTHERN AVE STE 106",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853011355",
"telephone_number": "602-512-3299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "SCOTT",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-01",
"last_updated": "2021-09-21",
"certification_date": "2021-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CT",
"license": "002756",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AZ",
"license": "2519",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.