Basic Information
Provider Information
NPI: 1003804121
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PODSCHUN
FirstName: JAMES
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: PODSCHUN
OtherFirstName: JAMES
OtherMiddleName: A
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: OD PA
OtherLastNameType: 2
Mailing Information
Address1: 1935 STATE ROAD 436 STE 1001
Address2:  
City: WINTER PARK
State: FL
PostalCode: 327922244
CountryCode: US
TelephoneNumber: 4076710960
FaxNumber: 4076776696
Practice Location
Address1: 1935 STATE ROAD 436 STE 1001
Address2:  
City: WINTER PARK
State: FL
PostalCode: 327922244
CountryCode: US
TelephoneNumber: 4076710960
FaxNumber: 4076776696
Other Information
ProviderEnumerationDate: 10/12/2005
LastUpdateDate: 02/05/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000XFLOP0002303FLY Eye and Vision Services ProvidersOptometrist 
152W00000XOPC2303FLN Eye and Vision Services ProvidersOptometrist 

ID Information
IDTypeStateIssuerDescription
07873530005FL MEDICAID


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