Healthcare Provider Details

I. General information

NPI: 1306835111
Provider Name (Legal Business Name): JOHN SCOTT SCHMUTZLER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 US 31 N
GREENWOOD IN
46142-4503
US

IV. Provider business mailing address

5355 MICHAEL CT
GREENWOOD IN
46142-9683
US

V. Phone/Fax

Practice location:
  • Phone: 317-881-6708
  • Fax:
Mailing address:
  • Phone: 317-881-6708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001994A/B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: