Provider Demographics
NPI:1801895891
Name:SCHULTZ, GREGORY MATTHEW (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MATTHEW
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 TEWNING RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2639
Mailing Address - Country:US
Mailing Address - Phone:757-229-1131
Mailing Address - Fax:757-229-1586
Practice Address - Street 1:101 TEWNING RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2639
Practice Address - Country:US
Practice Address - Phone:757-229-1131
Practice Address - Fax:757-229-1586
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001377152W00000X
IN18003497A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010070309Medicaid
VA143593OtherPIN/BCBS
U52642Medicare UPIN
VA005380V49Medicare ID - Type Unspecified