Healthcare Provider Details

I. General information

NPI: 1003909094
Provider Name (Legal Business Name): CHAD AARON SHULTZ O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 W WESTERN RESERVE RD
POLAND OH
44514-3541
US

IV. Provider business mailing address

10 DUTTON DR
YOUNGSTOWN OH
44502-1818
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-7691
  • Fax: 330-743-8368
Mailing address:
  • Phone: 330-746-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT005575
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: