Provider Demographics
NPI:1912955337
Name:HANDSCHUMACHER ENTERPRISES OD PA
Entity Type:Organization
Organization Name:HANDSCHUMACHER ENTERPRISES OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDSCHUMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-985-3937
Mailing Address - Street 1:7500 RAMBLE WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-4307
Mailing Address - Country:US
Mailing Address - Phone:919-981-4444
Mailing Address - Fax:
Practice Address - Street 1:7500 RAMBLE WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-4307
Practice Address - Country:US
Practice Address - Phone:919-981-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015J7Medicaid
NC2336592Medicare PIN
NC4954450001Medicare NSC