Healthcare Provider Details

I. General information

NPI: 1477708428
Provider Name (Legal Business Name): MICHAEL SCHLOFMAN O.D P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
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

PO BOX 190
STARKE FL
32091-0190
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4299
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL L SCHLOFMAN
Title or Position: DOCTOR
Credential: O.D.
Phone: 352-745-1374