Healthcare Provider Details

I. General information

NPI: 1578698312
Provider Name (Legal Business Name): SCOTT E SCHACHTER ODA PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 JAMES WAY STE 210
PISMO BEACH CA
93449-2874
US

IV. Provider business mailing address

300 JAMES WAY STE 210
PISMO BEACH CA
93449-2874
US

V. Phone/Fax

Practice location:
  • Phone: 805-773-6000
  • Fax: 805-773-2120
Mailing address:
  • Phone: 805-773-6000
  • Fax: 805-773-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT ERIC SCHACHTER
Title or Position: PRES
Credential: O.D.
Phone: 805-773-6000