Provider Demographics
NPI:1942518097
Name:JAMES A PODSCHUN OD PA
Entity Type:Organization
Organization Name:JAMES A PODSCHUN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PODSCHUN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-671-0960
Mailing Address - Street 1:1935 STATE ROAD 436 STE 1001
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2244
Mailing Address - Country:US
Mailing Address - Phone:407-671-0960
Mailing Address - Fax:407-677-6696
Practice Address - Street 1:1935 STATE ROAD 436 STE 1001
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2244
Practice Address - Country:US
Practice Address - Phone:407-671-0960
Practice Address - Fax:407-677-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2303152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLES083AMedicare PIN