Provider Demographics
NPI:1477605293
Name:SHRODER, STEVEN W (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:W
Last Name:SHRODER
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 1:1790 COMMERCE CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-6358
Mailing Address - Country:US
Mailing Address - Phone:937-878-3941
Mailing Address - Fax:937-878-3525
Practice Address - Street 1:1790 COMMERCE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-6358
Practice Address - Country:US
Practice Address - Phone:937-878-3941
Practice Address - Fax:937-878-3525
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0887849Medicaid
OH310824134029OtherCARESOURCE
SH0722142OtherMEDICARE LEGACY NUMBER
OH0251100001Medicare NSC
OHU33771Medicare UPIN