Provider Demographics
NPI:1598799801
Name:SCHUTT, ELWIN WINFIELD (OD)
Entity Type:Individual
Prefix:DR
First Name:ELWIN
Middle Name:WINFIELD
Last Name:SCHUTT
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:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-1599
Mailing Address - Country:US
Mailing Address - Phone:208-773-7434
Mailing Address - Fax:208-777-0836
Practice Address - Street 1:185 W 4TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5089
Practice Address - Country:US
Practice Address - Phone:208-773-7434
Practice Address - Fax:208-777-0836
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000773700Medicaid
IDV7322OtherBLUE CROSS OF IDAHO
ID6206340001Medicare NSC
IDT44297Medicare UPIN
ID15907211Medicare PIN