Provider Demographics
NPI:1275581126
Name:SCHLUTER, MARK LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEONARD
Last Name:SCHLUTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6805
Mailing Address - Country:US
Mailing Address - Phone:707-996-1900
Mailing Address - Fax:707-996-4396
Practice Address - Street 1:696 3RD ST W
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6805
Practice Address - Country:US
Practice Address - Phone:707-996-1900
Practice Address - Fax:707-996-4396
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87496207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G874960Medicaid
00G874960Medicare ID - Type Unspecified
CA00G874960Medicaid