Individual provider Active NPI

Jeffrey E Schultz, O.D.

Optometrist
Independence, OH

National Provider Identifier

1437153129

Registry record updated Oct 9, 2014

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Organizations & group practices2
NPI Registry JSON
Other providers in Independence, OH
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: OptometristTaxonomy code 152W00000X
License: 3146T157 Issued in OH
Practice address: 6060 Rockside Woods Blvd N
Ste 110
Independence, OH 44131-7303
Phone: (216) 581-8484
Fax: (216) 662-5445
NPI assigned: Jun 9, 2005
Sex: Male
Sole proprietor: No

NPPES NPI Registry

Updated by the provider on Oct 9, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)	Code	License	State	Primary
Optometrist	152W00000X	3146T157	OH	Primary
Corneal and Contact Management Optometrist	152WC0802X	3146T157	OH
Pediatric Optometrist	152WP0200X	3146T157	OH
Occupational Vision Optometrist	152WX0102X	3146T157	OH

Addresses

Primary practice location

6060 Rockside Woods Blvd N
Ste 110
Independence, OH 44131-7303

Mailing address

6060 Rockside Woods Blvd N
Ste 110
Independence, OH 44131-7303
Phone (216) 581-8484

Other identifiers 10

Identifier	Type	State	Issuer
34-1312900-00	Other	OH	WORKERS COMPENSATION
000000130192	Other	OH	BC/BS
0277123	Medicaid	OH
0413561	Other	OH	MEDICARE ID
9270432	Other	OH	MEDICARE PROVIDER NUMBER
000000164988	Other	OH	ANTHEM BC/BS
0470094-01-8	Other	OH	UNEMPLOYMENT
791580936	Other	OH	MEDICARE ID
0348410001	Other	OH	ADMINISTAR FEDERAL ID #
0004619475	Other	OH	AETNA PIN

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

Part B services: Yes
Medical equipment: Yes
Home health: Yes
Power mobility devices: No
Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
I20111227000513	OH	Practitioner - Optometry	7618997156	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Enrolled

State licenses

License	State	Type	Specialty
3146	OH	MD	Psychologist
3146T157	OH	MD	Corneal and Contact Management Optometrist

Practice roles

Organization	Specialty	Status	New patients
Clarkson Optometry Midwest Inc.	Optometrist	CurrentSince Mar 1, 2020	Accepting new patients

Interoperability endpoints

Direct secure messaging: jeffreyschultz@direct.eyecare-partners.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Clarkson Optometry Midwest Inc
- Optometrist
- Centerville, OH
- NPI 1073917597
OH
Medicare reassignment
Clarkson Optometry Midwest Inc.
- Optometrist
- Lebanon, OH
- NPI 1326781147
NPD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412812800000",
    "number": "1437153129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6060 ROCKSIDE WOODS BLVD N",
            "address_2": "STE 110",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441317303",
            "telephone_number": "216-581-8484",
            "fax_number": "216-662-5445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6060 ROCKSIDE WOODS BLVD N",
            "address_2": "STE 110",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441317303",
            "telephone_number": "216-581-8484",
            "fax_number": "216-662-5445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHULTZ",
        "first_name": "JEFFREY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2014-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3146T157",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "OH",
            "license": "3146T157",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "OH",
            "license": "3146T157",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "OH",
            "license": "3146T157",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "34-1312900-00",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "000000130192",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0277123",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "0413561",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "9270432",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "000000164988",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNEMPLOYMENT",
            "identifier": "0470094-01-8",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "791580936",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADMINISTAR FEDERAL ID #",
            "identifier": "0348410001",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "0004619475",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, OH

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.