Provider Demographics
NPI:1730181983
Name:SCHNEIDER, TIMOTHY LUKE (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LUKE
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 BEACH BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-8608
Mailing Address - Country:US
Mailing Address - Phone:904-247-5575
Mailing Address - Fax:904-247-3375
Practice Address - Street 1:1909 BEACH BLVD
Practice Address - Street 2:STE 101
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-8608
Practice Address - Country:US
Practice Address - Phone:904-247-5575
Practice Address - Fax:904-247-3375
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68823207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263753700Medicaid
FL27812BMedicare ID - Type Unspecified
FL263753700Medicaid