Provider Demographics
NPI:1437153129
Name:SCHULTZ, JEFFREY E (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:E
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 1:6060 ROCKSIDE WOODS BLVD N
Mailing Address - Street 2:STE 110
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-7303
Mailing Address - Country:US
Mailing Address - Phone:216-581-8484
Mailing Address - Fax:216-662-5445
Practice Address - Street 1:6060 ROCKSIDE WOODS BLVD N
Practice Address - Street 2:STE 110
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-7303
Practice Address - Country:US
Practice Address - Phone:216-581-8484
Practice Address - Fax:216-662-5445
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3146T157152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34-1312900-00OtherWORKERS COMPENSATION
OH000000130192OtherBC/BS
OH0277123Medicaid
OH0413561OtherMEDICARE ID
OH9270432OtherMEDICARE PROVIDER NUMBER
OH000000164988OtherANTHEM BC/BS
OH0470094-01-8OtherUNEMPLOYMENT
OH791580936OtherMEDICARE ID
OH0348410001OtherADMINISTAR FEDERAL ID #
OH0004619475OtherAETNA PIN
OHT46746Medicare UPIN