Provider Demographics
NPI:1902808231
Name:CHENORE, SCOTT ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:CHENORE
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 1:5290 W 9TH STREET DR
Mailing Address - Street 2:STE 300
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4458
Mailing Address - Country:US
Mailing Address - Phone:970-353-5560
Mailing Address - Fax:970-304-6809
Practice Address - Street 1:5290 W 9TH STREET DR
Practice Address - Street 2:STE 300
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4458
Practice Address - Country:US
Practice Address - Phone:970-353-5560
Practice Address - Fax:970-304-6809
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1433152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08014334Medicaid
COC42143Medicare PIN
CO0209580001Medicare NSC