=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770648453
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH L SCHAFFER O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1744 N FEDERAL HWY
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33305-2558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-561-5400
-----------------------------------------------------
Fax | 954-561-4761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1744 N FEDERAL HWY
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33305-2558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-561-5400
-----------------------------------------------------
Fax | 954-561-4761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC2742
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------