Provider Demographics
NPI:1235144106
Name:SCHAUBACH, OLIVIA LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:LEE
Last Name:SCHAUBACH
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 1:110 PROFESSIONAL PARK DR SE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6735
Mailing Address - Country:US
Mailing Address - Phone:540-552-4573
Mailing Address - Fax:540-552-4612
Practice Address - Street 1:110 PROFESSIONAL PARK DR SE
Practice Address - Street 2:SUITE 5
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6735
Practice Address - Country:US
Practice Address - Phone:540-552-4573
Practice Address - Fax:540-552-4612
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001327152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010046033Medicaid
VAU99507Medicare UPIN
VAC05777Medicare Oscar/Certification
VAC05777Medicare PIN
VA010046033Medicaid