Provider Demographics
NPI:1922011261
Name:SCHULTZ, BETH L (OPTOMETRIST)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:L
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9803 HICKORY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5044
Mailing Address - Country:US
Mailing Address - Phone:214-578-4171
Mailing Address - Fax:
Practice Address - Street 1:6201 SOUTH FWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-2001
Practice Address - Country:US
Practice Address - Phone:817-568-6143
Practice Address - Fax:817-551-4630
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000770152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1646973OtherBLUE SHIELD
PA2248OtherAETNA HMO
PA2323907000OtherKEYSTONE EAST
PA2323907000OtherKEYSTONE EAST
PA2248OtherAETNA HMO