Provider Demographics
NPI:1366502056
Name:SCHAEFER, JAMES M (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
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 1:217 DELANO AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2276
Mailing Address - Country:US
Mailing Address - Phone:740-772-1105
Mailing Address - Fax:740-772-1105
Practice Address - Street 1:217 DELANO AVE STE D
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2276
Practice Address - Country:US
Practice Address - Phone:740-772-1105
Practice Address - Fax:740-772-1105
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3000T636152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH57818OtherDAVIS VISION
OH000000525319OtherBLUE CROSS BLUE SHIELD
OH0005255084OtherAETNA
OH0244711OtherMOLINA
OHOH3000OtherEYEMED
OH0244711Medicaid
OH113805744026OtherCARESOURCE
OHJS46590OtherSPECTERA
OH0244711Medicaid
OH0407956Medicare PIN
OH5966270001Medicare NSC
OH113805744026OtherCARESOURCE
OHP00389013Medicare PIN