Provider Demographics
NPI:1003835778
Name:SCHNEIDER, TODD M (OD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3053
Mailing Address - Country:US
Mailing Address - Phone:920-887-1151
Mailing Address - Fax:920-887-3353
Practice Address - Street 1:705 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3053
Practice Address - Country:US
Practice Address - Phone:920-887-1151
Practice Address - Fax:920-887-3353
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1413152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1006595OtherPHYSICIANS PLUS HMO
WI410032599OtherRAIL ROAD MEDICARE
WI10365OtherCEAN CARE HMO
WI38562000Medicaid
WI0117OtherJOHN DEERE HEALTH PLAN
WI39115615603OtherUNITY HMO
391156156OtherTAX ID
WI12233OtherNETWORK HEALTH PLAN
T63247Medicare UPIN
391156156OtherTAX ID