Provider Demographics
NPI:1841516002
Name:DR GREGORY SCHACHTMAN PA
Entity type:Organization
Organization Name:DR GREGORY SCHACHTMAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHACHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-561-8880
Mailing Address - Street 1:2140 E OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1109
Mailing Address - Country:US
Mailing Address - Phone:954-561-8880
Mailing Address - Fax:954-563-9979
Practice Address - Street 1:2140 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1109
Practice Address - Country:US
Practice Address - Phone:954-561-8880
Practice Address - Fax:954-563-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2559152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620686701Medicaid
FLDA116AMedicare UPIN