Provider Demographics
NPI:1467687012
Name:SCHLIEVERT, RICHARD CHARLES (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHARLES
Last Name:SCHLIEVERT
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 1:2275 MARIETTA BLVD NW STE 270-314
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2004
Mailing Address - Country:US
Mailing Address - Phone:678-438-5612
Mailing Address - Fax:678-623-3633
Practice Address - Street 1:2275 MARIETTA BLVD NW # 270-314
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2004
Practice Address - Country:US
Practice Address - Phone:678-438-5612
Practice Address - Fax:678-623-3633
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA611719687AMedicaid