Provider Demographics
NPI:1235239880
Name:SCHEEL, MARK THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:SCHEEL
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:S75W12605 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-4023
Mailing Address - Country:US
Mailing Address - Phone:414-425-8123
Mailing Address - Fax:
Practice Address - Street 1:W226S1500 STATE ROAD 164
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1428
Practice Address - Country:US
Practice Address - Phone:262-521-9460
Practice Address - Fax:262-521-9482
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT63212Medicare UPIN
WI87892Medicare ID - Type Unspecified