MEDICARE: EDWIN M SCHOTT OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000103	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38767	OTHER	PA	COLE MANAGED VISION DR#
2	PA5169	OTHER	PA	EYEMED
3	SC030043	OTHER	PA	HIGHMARK BCBS
4	323300	OTHER	PA	UPMC PROVIDER #
5	50059	OTHER	PA	DAVIS VISION
6	PA05169	OTHER	PA	VBA

General Provider Information

NPI Number	:	1366442535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN M SCHOTT OD

Provider Business Mailing Address
First Line	:	21 WILLOW ST
Second Line	:
City	:	PORT ALLEGANY
State	:	PA
Zip	:	16743-1334
Country	:	US
Telephone Number	:	814-642-9408
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 WILLOW ST
Second Line	:
City	:	PORT ALLEGANY
State	:	PA
Zip	:	16743-1334
Country	:	US
Telephone Number	:	814-642-9408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	03/16/2011

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