Provider Demographics
NPI:1366442535
Name:SCHOTT, EDWIN M (OD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:M
Last Name:SCHOTT
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 1:21 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEGANY
Mailing Address - State:PA
Mailing Address - Zip Code:16743-1334
Mailing Address - Country:US
Mailing Address - Phone:814-642-9408
Mailing Address - Fax:
Practice Address - Street 1:21 WILLOW ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEGANY
Practice Address - State:PA
Practice Address - Zip Code:16743-1334
Practice Address - Country:US
Practice Address - Phone:814-642-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA38767OtherCOLE MANAGED VISION DR#
PAPA5169OtherEYEMED
PASC030043OtherHIGHMARK BCBS
PA323300OtherUPMC PROVIDER #
PA50059OtherDAVIS VISION
PAPA05169OtherVBA
PAPA5169OtherEYEMED
PA0214230001Medicare NSC
PA38767OtherCOLE MANAGED VISION DR#