Provider Demographics
NPI:1871593376
Name:BIXLER, SCOTT D (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:BIXLER
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 1:305 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-2006
Mailing Address - Country:US
Mailing Address - Phone:260-589-2020
Mailing Address - Fax:260-589-3068
Practice Address - Street 1:305 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-2006
Practice Address - Country:US
Practice Address - Phone:260-589-2020
Practice Address - Fax:260-589-3068
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN183320BOtherWPS MEDICARE PART B
IN410046380OtherRAILROAD MEDICARE
IN200336400Medicaid
INU86489Medicare UPIN
IN0412500001Medicare NSC
IN183320BMedicare PIN