Healthcare Provider Details

I. General information

NPI: 1013997055
Provider Name (Legal Business Name): ARTHUR LEONARD SCHLOFMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 S WALNUT ST
STARKE FL
32091-4413
US

IV. Provider business mailing address

1105 S WALNUT ST P.O. BOX 190
STARKE FL
32091-4413
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-8076
  • Fax: 904-964-8107
Mailing address:
  • Phone: 904-964-8076
  • Fax: 904-964-8107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 1499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: