Provider Demographics
NPI:1578698312
Name:SCOTT E SCHACHTER ODA PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SCOTT E SCHACHTER ODA PROFESSIONAL CORPORATION
Other - Org Name:ADVANCED EYECARE-EYEWEAR OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SCHACHTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-773-6000
Mailing Address - Street 1:300 JAMES WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2874
Mailing Address - Country:US
Mailing Address - Phone:805-773-6000
Mailing Address - Fax:805-773-2120
Practice Address - Street 1:300 JAMES WAY STE 210
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2874
Practice Address - Country:US
Practice Address - Phone:805-773-6000
Practice Address - Fax:805-773-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0093530Medicaid
CAWY197Medicare PIN
CASD0093530Medicaid