Provider Demographics
NPI:1114987914
Name:SCHULTZ, TERRY LEE (OD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
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 1:50 N PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1757
Mailing Address - Country:US
Mailing Address - Phone:866-587-8790
Mailing Address - Fax:740-477-8349
Practice Address - Street 1:210 SHARON RD
Practice Address - Street 2:SUITE B
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-0463
Practice Address - Country:US
Practice Address - Phone:800-948-3937
Practice Address - Fax:740-477-8349
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4231T1189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH831050Medicaid
U28736Medicare UPIN
OH831050Medicaid