Provider Demographics
NPI:1003804121
Name:PODSCHUN, JAMES A (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:PODSCHUN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:A
Other - Last Name:PODSCHUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD PA
Mailing Address - Street 1:1935 STATE ROAD 436 STE 1001
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2244
Mailing Address - Country:US
Mailing Address - Phone:407-671-0960
Mailing Address - Fax:407-677-6696
Practice Address - Street 1:1935 STATE ROAD 436 STE 1001
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2244
Practice Address - Country:US
Practice Address - Phone:407-671-0960
Practice Address - Fax:407-677-6696
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2303152W00000X
FLFLOP0002303152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078735300Medicaid
FL593036051OtherTAX ID NUMBER
FL593036051OtherTAX ID NUMBER
FLU02065Medicare UPIN