Provider Demographics
NPI:1063494763
Name:SCHULTZ, JEFFREY PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
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 1:8 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2493
Mailing Address - Country:US
Mailing Address - Phone:828-258-1586
Mailing Address - Fax:828-258-6161
Practice Address - Street 1:1419 PATTON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1721
Practice Address - Country:US
Practice Address - Phone:828-254-3883
Practice Address - Fax:828-254-3853
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093MCOtherBCBS PROV #
NC89093MCMedicaid
NC093MCOtherBCBS PROV #
NC89093MCMedicaid
NC2472489AMedicare ID - Type Unspecified
NC2472489GMedicare PIN
NC2472489CMedicare PIN