Provider Demographics
NPI:1205817970
Name:SCHOTT, KIRK ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:ROBERT
Last Name:SCHOTT
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:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:BRUCE CROSSING
Mailing Address - State:MI
Mailing Address - Zip Code:49912-0254
Mailing Address - Country:US
Mailing Address - Phone:906-827-3559
Mailing Address - Fax:906-827-3559
Practice Address - Street 1:20312 HIGHWAY M-28 WEST
Practice Address - Street 2:SUITE C
Practice Address - City:EWEN
Practice Address - State:MI
Practice Address - Zip Code:49925
Practice Address - Country:US
Practice Address - Phone:906-988-2752
Practice Address - Fax:906-988-2753
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL706042152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900F600060OtherBLUE CROSS/BLUE SHIELD OF
MI944461169Medicaid
MION62510Medicare PIN
MI944461169Medicaid
0195940002Medicare NSC