Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5451 | NJ |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 5451 | NJ |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 5451 | NJ |
N | 152WP0200X | Pediatric Optomitrist | 5451 | NJ |
N | 152WS0006X | Sports Vision | 5451 | NJ |
N | 152WV0400X | Optomitrist - Vision Therapist | 5451 | NJ |
N | 152WX0102X | Occupational Vision | 5451 | NJ |
NPI | 1265427132 |
---|---|
Provider Name | Scott R. Schultz |
First Address | West Orange, NJ 07052-1103 |
Second Address | West Orange, NJ 07052-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 29/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U66268 | (02) | NJ |