Basic Information
| Provider Information | |||||||||
| NPI: | 1790081131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCATTON | ||||||||
| FirstName: | RENEE | ||||||||
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| Credential: | LO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 NEEDHAM ST | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024611615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179646681 | ||||||||
| FaxNumber: | 6176300141 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 BARNES RD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | WALLINGFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064921832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036781201 | ||||||||
| FaxNumber: | 2036781209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2011 | ||||||||
| LastUpdateDate: | 02/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 001311 | CT | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.