MEDICARE: DR. ELWIN WINFIELD SCHUTT O.D.

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	ODP-499	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	V7322	OTHER	ID	BLUE CROSS OF IDAHO

General Provider Information

NPI Number	:	1598799801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELWIN WINFIELD SCHUTT O.D.

Provider Business Mailing Address
First Line	:	PO BOX 1599
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83877-1599
Country	:	US
Telephone Number	:	208-773-7434
Fax Number	:	208-777-0836

Provider Business Practice Location Address
First Line	:	185 W 4TH AVE
Second Line	:	SUITE A
City	:	POST FALLS
State	:	ID
Zip	:	83854-5089
Country	:	US
Telephone Number	:	208-773-7434
Fax Number	:	208-777-0836

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	06/11/2009

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