Provider Demographics
NPI:1164584793
Name:SCHROEDER, STEPHEN GERARD (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GERARD
Last Name:SCHROEDER
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 1:31897 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-2629
Mailing Address - Country:US
Mailing Address - Phone:951-244-1122
Mailing Address - Fax:
Practice Address - Street 1:25321 RAILROAD CANYON DR.
Practice Address - Street 2:#503
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532
Practice Address - Country:US
Practice Address - Phone:951-244-1122
Practice Address - Fax:951-244-2777
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8321T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10676Medicare UPIN