Provider Demographics
NPI:1437137833
Name:SCHROCK, RITA E (OPTOMETRIST)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:E
Last Name:SCHROCK
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 MIFFLIN AVE SUITE 110
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805
Mailing Address - Country:US
Mailing Address - Phone:419-289-0808
Mailing Address - Fax:
Practice Address - Street 1:2212 MIFFLIN AVE SUITE 110
Practice Address - Street 2:
Practice Address - City:ASHLSND
Practice Address - State:OH
Practice Address - Zip Code:44805
Practice Address - Country:US
Practice Address - Phone:419-289-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4491152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0601590001Medicare NSC
OH0749013Medicare PIN