Provider Demographics
NPI:1265427132
Name:SCHULTZ, SCOTT R (OD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-0111
Mailing Address - Country:US
Mailing Address - Phone:201-869-2020
Mailing Address - Fax:973-736-8580
Practice Address - Street 1:DR. SCOTT SCHULTZ
Practice Address - Street 2:521 FRANKLIN AVENUE
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110
Practice Address - Country:US
Practice Address - Phone:973-667-0600
Practice Address - Fax:973-667-5509
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2025-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ5451152WS0006X, 152W00000X, 152WX0102X, 152WV0400X, 152WC0802X, 152WL0500X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU66268Medicare UPIN
NJ728156Medicare PIN