Provider Demographics
NPI:1497851497
Name:DAVID M SHULTZ M D , INC
Entity Type:Organization
Organization Name:DAVID M SHULTZ M D , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-349-8300
Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4109
Mailing Address - Country:US
Mailing Address - Phone:818-349-8300
Mailing Address - Fax:818-349-2214
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4145
Practice Address - Country:US
Practice Address - Phone:818-349-8300
Practice Address - Fax:818-349-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13046207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G130460Medicaid
CA00G130460Medicaid
CAA38869Medicare UPIN
CA0741190001Medicare NSC