Individual
DR. SCOTT L DERCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2044 SUNRISE HWY, BAY SHORE, NY 11706-6018
(631) 666-9595
(631) 206-1968
Mailing address
188 GLEN SUMMER RD, HOLBROOK, NY 11741-5029
(631) 472-2552
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
VUT-4532-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01964218
—
NY
Enumeration date
03/19/2007
Last updated
05/01/2008
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