Provider Demographics
NPI:1043305899
Name:SCHAFF VISION CARE, LLC
Entity Type:Organization
Organization Name:SCHAFF VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-789-8119
Mailing Address - Street 1:2700 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3933
Mailing Address - Country:US
Mailing Address - Phone:517-789-8119
Mailing Address - Fax:517-789-6276
Practice Address - Street 1:2700 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3933
Practice Address - Country:US
Practice Address - Phone:517-789-8119
Practice Address - Fax:517-789-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5348270003Medicare NSC