Provider Demographics
NPI:1295816866
Name:SCHAEFER, JOHN W (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:SCHAEFER
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 1:205 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-2109
Mailing Address - Country:US
Mailing Address - Phone:608-847-6264
Mailing Address - Fax:608-847-7279
Practice Address - Street 1:205 DIVISION ST
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-2109
Practice Address - Country:US
Practice Address - Phone:608-847-6264
Practice Address - Fax:608-847-7279
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38516200Medicaid
WI87-433Medicare ID - Type UnspecifiedMEDICARE
WI38516200Medicaid