Provider Demographics
NPI:1447230602
Name:SCHACHTER, SCOTT ERIC (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ERIC
Last Name:SCHACHTER
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 1:300 JAMES WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2873
Mailing Address - Country:US
Mailing Address - Phone:805-773-6000
Mailing Address - Fax:805-773-2120
Practice Address - Street 1:300 JAMES WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2873
Practice Address - Country:US
Practice Address - Phone:805-773-6000
Practice Address - Fax:805-773-2120
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9353152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA352214885OtherBLUE CROSS
CASD0009353Medicaid
CA5179480001Medicare NSC
CAU13893Medicare UPIN
CAWOP9353FMedicare PIN