Provider Demographics
NPI:1073900718
Name:SCHAEFER, ANGELLA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELLA
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 20TH ST NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-2930
Mailing Address - Country:US
Mailing Address - Phone:507-332-9900
Mailing Address - Fax:
Practice Address - Street 1:1575 20TH ST NW
Practice Address - Street 2:SUITE 101
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-2930
Practice Address - Country:US
Practice Address - Phone:507-332-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND731152W00000X
MN3495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist