Healthcare Provider Details

I. General information

NPI: 1801043641
Provider Name (Legal Business Name): MICHAEL LEONARD SCHLOFMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 LAFAYETTE ST
STARKE FL
32091
US

IV. Provider business mailing address

PO BOX 190
STARKE FL
32091-0190
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: