Provider Demographics
NPI:1962455352
Name:EDWIN M SCHOTT OD PC
Entity Type:Organization
Organization Name:EDWIN M SCHOTT OD PC
Other - Org Name:SCHOTT ASSOCIATES EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-642-9408
Mailing Address - Street 1:21 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEGANY
Mailing Address - State:PA
Mailing Address - Zip Code:16743-1334
Mailing Address - Country:US
Mailing Address - Phone:814-642-9408
Mailing Address - Fax:814-642-9484
Practice Address - Street 1:21 WILLOW ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEGANY
Practice Address - State:PA
Practice Address - Zip Code:16743-1334
Practice Address - Country:US
Practice Address - Phone:814-642-9408
Practice Address - Fax:814-642-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000103152W00000X
PAOEG001451152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC835524OtherHIGHMARK GRP
PASC835524OtherHIGHMARK GRP
PA0214230001Medicare NSC