Provider Demographics
NPI:1497820716
Name:SCHULTZ, JOEL JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:JAMES
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1564 GLEN ERIN DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7727
Mailing Address - Country:US
Mailing Address - Phone:843-442-9147
Mailing Address - Fax:843-856-9353
Practice Address - Street 1:105 S CEDAR ST
Practice Address - Street 2:SUITE F
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6078
Practice Address - Country:US
Practice Address - Phone:843-832-4520
Practice Address - Fax:843-871-2269
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD10110Medicaid