Provider Demographics
NPI:1528124153
Name:SCRUGGS, STEVEN CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHARLES
Last Name:SCRUGGS
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 1:261 MARINE DR
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-4325
Mailing Address - Country:US
Mailing Address - Phone:503-325-4641
Mailing Address - Fax:
Practice Address - Street 1:261 MARINE DR
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4325
Practice Address - Country:US
Practice Address - Phone:503-325-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1612ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR840481000OtherBLUE CROSS
OR840481000OtherBLUE CROSS
OR6216750001Medicare NSC
ORT68114Medicare UPIN