Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3439T880 | OH |
NPI | 1013082056 |
---|---|
Provider Name | Dr. Herbert J Shultz |
First Address | Salem, OH 44460 |
Second Address | Salem, OH 44460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 27/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0441678 | (05) | OH |
T47219 | (02) |