Provider Demographics
NPI:1003884230
Name:SCHULTZ, LANCE PRESTON (OD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:PRESTON
Last Name:SCHULTZ
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 1:167 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8247
Mailing Address - Country:US
Mailing Address - Phone:508-875-8800
Mailing Address - Fax:508-270-3927
Practice Address - Street 1:167 UNION AVE
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8247
Practice Address - Country:US
Practice Address - Phone:508-875-8800
Practice Address - Fax:508-270-3927
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 3188152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353299Medicaid
MA0353299Medicaid