Provider Demographics
NPI:1063836625
Name:SCHOTT VISION CARE PA
Entity Type:Organization
Organization Name:SCHOTT VISION CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SCHOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-647-2020
Mailing Address - Street 1:600 S ORLANDO AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5660
Mailing Address - Country:US
Mailing Address - Phone:407-647-2020
Mailing Address - Fax:407-628-1216
Practice Address - Street 1:600 S ORLANDO AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5660
Practice Address - Country:US
Practice Address - Phone:407-647-2020
Practice Address - Fax:407-628-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4666152W00000X
FLOPC1011152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHD4992Medicare UPIN