Provider Demographics
NPI:1164744488
Name:TIMOTHY L SCHNEIDER, MD PA
Entity Type:Organization
Organization Name:TIMOTHY L SCHNEIDER, MD PA
Other - Org Name:SCHNEIDER EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-247-5575
Mailing Address - Street 1:1909 BEACH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-8608
Mailing Address - Country:US
Mailing Address - Phone:904-247-5575
Mailing Address - Fax:904-247-3375
Practice Address - Street 1:1909 BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-8608
Practice Address - Country:US
Practice Address - Phone:904-247-5575
Practice Address - Fax:904-247-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 68823207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263753700Medicaid
FLF81434Medicare UPIN