Provider Demographics
NPI:1548352131
Name:GITTINS, SCOTT E (OD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:GITTINS
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 1:6809 FIVE STAR BLVD
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2687
Mailing Address - Country:US
Mailing Address - Phone:916-624-2020
Mailing Address - Fax:916-624-3027
Practice Address - Street 1:6809 FIVE STAR BLVD
Practice Address - Street 2:SUITE 101A
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2687
Practice Address - Country:US
Practice Address - Phone:916-624-2020
Practice Address - Fax:916-624-3027
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9752T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0097521Medicare ID - Type Unspecified
CAU34524Medicare UPIN