Basic Information
| Provider Information | |||||||||
| NPI: | 1538169784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLONNA | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 891 WESTMINSTER ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013317850 | ||||||||
| FaxNumber: | 4012744739 | ||||||||
| Practice Location | |||||||||
| Address1: | 891 WESTMINSTER ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013317850 | ||||||||
| FaxNumber: | 4012744739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 04/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WP0200X | ODTA-00491 | RI | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152W00000X | ODTA-00491 | RI | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 22-00960 | 01 | UNITED HEALTH CARE | OTHER | 419082077 | 01 | RI | MEDICARE OTHER | OTHER | 9022661 | 05 | RI | MEDICAID | 580001245 | 01 | RAILROAD/METRA HEALTH | OTHER | 27925 | 01 | RI | NEIGHBORHOOD HEALTH PLAN | OTHER | 814844 | 01 | MASHANTUCKET PEQUOT TRIBE | OTHER | 0000025743 | 01 | RI | BLUE CROSS BLUE SHIELD | OTHER | 4866944001 | 01 | CIGNA INSURANCE | OTHER | 3314220 | 01 | AETNA INSURANCE | OTHER | 030510109 | 01 | VISION SERVICE PLAN | OTHER | 409736 | 01 | RI | BLUE CHIP RI | OTHER |