Provider Demographics
NPI:1639755861
Name:SCHULTZ FAMILY EYECARE
Entity Type:Organization
Organization Name:SCHULTZ FAMILY EYECARE
Other - Org Name:JODI SCHULTZ, O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-688-1121
Mailing Address - Street 1:129 N WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3561
Mailing Address - Country:US
Mailing Address - Phone:214-325-8045
Mailing Address - Fax:
Practice Address - Street 1:129 N WAYNE AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3561
Practice Address - Country:US
Practice Address - Phone:214-325-8045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028724530001Medicaid