Gordon Quatlebaum Scott Jr., OPTICIAN

Primary specialty

OpticianTaxonomy code 156FX1800X

License

352 Issued in SC

Practice address

1812 Washington St
Columbia, SC 29201-3549

Phone

(803) 254-9381

Fax

(803) 254-1978

NPI assigned

Feb 28, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Robertson Optical Laboratories Inc

  • Eyewear Supplier
  • Columbia, SC
  • NPI 1851430839
  NPD (past) Authorized official

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1447387048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 COMMERCE DR NE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29223",
            "telephone_number": "803-254-9381",
            "fax_number": "803-254-1978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 WASHINGTON ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292013549",
            "telephone_number": "803-254-9381",
            "fax_number": "803-254-1978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "GORDON",
        "middle_name": "QUATLEBAUM",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "OPTICIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "SC",
            "license": "352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DV0105",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Davis Lee Scott II, L.M.T.
• Dumetz Scott
• Elizabeth Leigh Scott, PA
• Faith Tangel Scott, APRN
• Genora Scott
• Iman Shardey Scott
• James Mitchell Scott, DMD
• Jeannine Shanelle Scott
• Karneisha Virginia Scott, LMT
• Kenya Scott, D.C.

• Optician in Columbia, SC
• Providers in Columbia, SC by specialty
• Optician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.