Healthcare Provider Details

I. General information

NPI: 1063836625
Provider Name (Legal Business Name): SCHOTT VISION CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S ORLANDO AVE SUITE 300
MAITLAND FL
32751-5660
US

IV. Provider business mailing address

600 S ORLANDO AVE SUITE 300
MAITLAND FL
32751-5660
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-2020
  • Fax: 407-628-1216
Mailing address:
  • Phone: 407-647-2020
  • Fax: 407-628-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPC1011
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4666
License Number StateFL

VIII. Authorized Official

Name: DR. RYAN WAYNE SCHOTT
Title or Position: DIRECTOR
Credential: O.D.
Phone: 407-647-2020