1831370840 NPI number — JEFFREY E. SCHULTZ, O.D., INC

Table of content: (NPI 1831370840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831370840 NPI number — JEFFREY E. SCHULTZ, O.D., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY E. SCHULTZ, O.D., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831370840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6060 ROCKSIDE WOODS BLVD N
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44131-7303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-581-8484
Provider Business Mailing Address Fax Number:
216-662-5445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6060 ROCKSIDE WOODS BLVD N
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44131-7303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-581-8484
Provider Business Practice Location Address Fax Number:
216-662-5445
Provider Enumeration Date:
11/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
216-581-8484

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3416T157 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0277123 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0413561 . This is a "RENDERING ID#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1437153129 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0348410001 . This is a "ADMINISTAR FEDERAL ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9270432 . This is a "OHIO-MEDICARE P10 NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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