Provider Demographics
NPI:1316037864
Name:SCHROEDER, SKY (OD)
Entity Type:Individual
Prefix:DR
First Name:SKY
Middle Name:
Last Name:SCHROEDER
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 1:411 NE AVERY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3069
Mailing Address - Country:US
Mailing Address - Phone:541-264-7726
Mailing Address - Fax:541-272-3035
Practice Address - Street 1:411 NE AVERY ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3069
Practice Address - Country:US
Practice Address - Phone:541-264-7726
Practice Address - Fax:541-272-3035
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2839T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R152811Medicare UPIN