Provider Demographics
NPI:1003117664
Name:SCHAEFER & ASSOCIATES MANAGEMENT LLC
Entity Type:Organization
Organization Name:SCHAEFER & ASSOCIATES MANAGEMENT LLC
Other - Org Name:HARTFORD VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-251-2020
Mailing Address - Street 1:23 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-1868
Mailing Address - Country:US
Mailing Address - Phone:262-673-7711
Mailing Address - Fax:262-673-7712
Practice Address - Street 1:23 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-1868
Practice Address - Country:US
Practice Address - Phone:262-673-7711
Practice Address - Fax:262-673-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4966820001Medicare NSC