Provider Demographics
NPI:1013190867
Name:SCHLOSS, MICHAEL D (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:SCHLOSS
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 1:14433 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3309
Mailing Address - Country:US
Mailing Address - Phone:216-291-1255
Mailing Address - Fax:216-291-6877
Practice Address - Street 1:14433 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-3309
Practice Address - Country:US
Practice Address - Phone:216-291-1255
Practice Address - Fax:216-291-6877
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3145T638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0345371Medicaid
0440203Medicare PIN
OHT46901Medicare UPIN