Provider Demographics
NPI:1538149570
Name:SAUNDERS, SCOTT EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 WILLOW ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-2092
Mailing Address - Country:US
Mailing Address - Phone:860-379-7514
Mailing Address - Fax:860-379-8505
Practice Address - Street 1:140 WILLOW ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-2092
Practice Address - Country:US
Practice Address - Phone:860-379-7514
Practice Address - Fax:860-379-8505
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT001055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004069795Medicaid
CT0410000397Medicare NSC
CT004069795Medicaid