Provider Demographics
NPI:1770648453
Name:SCHAFFER, JUDITH L (OD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:L
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1744 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2558
Mailing Address - Country:US
Mailing Address - Phone:954-561-5400
Mailing Address - Fax:954-561-4761
Practice Address - Street 1:1744 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-2558
Practice Address - Country:US
Practice Address - Phone:954-561-5400
Practice Address - Fax:954-561-4761
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU74870Medicare UPIN