Provider Demographics
NPI:1235220179
Name:SCHAUER, KENT R (OD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:R
Last Name:SCHAUER
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 1:4101 MORRIS ST NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3605
Mailing Address - Country:US
Mailing Address - Phone:505-299-4426
Mailing Address - Fax:505-299-3746
Practice Address - Street 1:4101 MORRIS ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3605
Practice Address - Country:US
Practice Address - Phone:505-299-4426
Practice Address - Fax:505-299-3746
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM01P518OtherBCBS OF NEW MEXICO
NMP5283Medicaid
NM2590804Medicare PIN