Provider Demographics
NPI:1255663639
Name:RICHARD J. SHULDINER, OD, FAAO, PC
Entity type:Organization
Organization Name:RICHARD J. SHULDINER, OD, FAAO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SHULDINER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-898-2020
Mailing Address - Street 1:761 PAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8494
Mailing Address - Country:US
Mailing Address - Phone:951-898-2020
Mailing Address - Fax:951-898-2021
Practice Address - Street 1:761 PAYETTE DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-8494
Practice Address - Country:US
Practice Address - Phone:951-898-2020
Practice Address - Fax:951-898-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5203T152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty