Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046.010834 | IL |
NPI | 1003191875 |
---|---|
Provider Name | Dean Edward Schultz III |
First Address | Montgomery, AL 36112-6027 |
Second Address | Montgomery, AL 36112-6027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2011 |
Last Update Date | 21/07/2021 |