Provider Demographics
NPI:1609900034
Name:SCHULTZ, JAMES RICHARD (RO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:RO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3148
Mailing Address - Country:US
Mailing Address - Phone:401-943-3937
Mailing Address - Fax:401-397-7557
Practice Address - Street 1:1180 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3148
Practice Address - Country:US
Practice Address - Phone:401-943-3937
Practice Address - Fax:401-397-7557
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOP115156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0683571Medicaid