Provider Demographics
NPI:1457654261
Name:JEAN H. SCHOTT, M.D., S.C.
Entity Type:Organization
Organization Name:JEAN H. SCHOTT, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-946-4906
Mailing Address - Street 1:5505 CURTISS DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-8718
Mailing Address - Country:US
Mailing Address - Phone:920-946-4906
Mailing Address - Fax:920-457-3419
Practice Address - Street 1:2209 S MEMORIAL PL
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3715
Practice Address - Country:US
Practice Address - Phone:920-459-8811
Practice Address - Fax:920-459-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24256207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30427600Medicaid
WIB56414Medicare UPIN