Basic Information
| Provider Information | |||||||||
| NPI: | 1003804121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PODSCHUN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PODSCHUN | ||||||||
| OtherFirstName: | JAMES | ||||||||
| OtherMiddleName: | A | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC2303 | FL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | FLOP0002303 | FL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 078735300 | 05 | FL | MEDICAID |