Provider Demographics
NPI:1538169784
Name:COLONNA, SCOTT A (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:COLONNA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:891 WESTMINSTER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4020
Mailing Address - Country:US
Mailing Address - Phone:401-331-7850
Mailing Address - Fax:401-274-4739
Practice Address - Street 1:891 WESTMINSTER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4020
Practice Address - Country:US
Practice Address - Phone:401-331-7850
Practice Address - Fax:401-274-4739
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA-00491152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI409736OtherBLUE CHIP RI
030510109OtherVISION SERVICE PLAN
RI419082077OtherMEDICARE OTHER
580001245OtherRAILROAD/METRA HEALTH
RI27925OtherNEIGHBORHOOD HEALTH PLAN
RI9022661Medicaid
RI0000025743OtherBLUE CROSS BLUE SHIELD
3314220OtherAETNA INSURANCE
4866944001OtherCIGNA INSURANCE
22-00960OtherUNITED HEALTH CARE
814844OtherMASHANTUCKET PEQUOT TRIBE
814844OtherMASHANTUCKET PEQUOT TRIBE
RI27925OtherNEIGHBORHOOD HEALTH PLAN
3314220OtherAETNA INSURANCE