Individual
MR. GORDON QUATLEBAUM SCOTT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
1812 WASHINGTON ST, COLUMBIA, SC 29201-3549
(803) 254-9381
(803) 254-1978
Mailing address
411 COMMERCE DR NE, COLUMBIA, SC 29223
(803) 254-9381
(803) 254-1978
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
352
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DV0105
—
SC
Enumeration date
02/28/2007
Last updated
07/09/2007
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