Provider Demographics
NPI:1255301362
Name:SCHACKNOW, PAUL N (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:N
Last Name:SCHACKNOW
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SE RIVERSIDE DR STE 302
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2579
Mailing Address - Country:US
Mailing Address - Phone:772-287-9000
Mailing Address - Fax:772-287-0507
Practice Address - Street 1:509 SE RIVERSIDE DR STE 302
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2579
Practice Address - Country:US
Practice Address - Phone:772-287-9000
Practice Address - Fax:772-287-0507
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55008207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09423OtherBCBS
FL063674600Medicaid
FL063674600Medicaid
FL09423ZMedicare PIN