Provider Demographics
NPI:1477748085
Name:SCHLAUDERAFF, LARRY JAMES (OD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:JAMES
Last Name:SCHLAUDERAFF
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 1:202 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2703
Mailing Address - Country:US
Mailing Address - Phone:218-326-0358
Mailing Address - Fax:218-326-0566
Practice Address - Street 1:202 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2703
Practice Address - Country:US
Practice Address - Phone:218-326-0358
Practice Address - Fax:218-326-0566
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2415152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3C837EYOtherBLUE SHIELD
3C837EYOtherBLUE PLUS
3C838SCOtherBLUE SHIELD
3C838SCOtherBLUE PLUS
2200897OtherMEDICA GR
HP29720OtherHEALTH PARTNERS
4C427EYOtherMINN CARE BLUE PLUS
1008835OtherCOPORATE BENEFIT SERV
974251008835OtherPREFERRED ONE
U33589OtherFIRST PLAN BLE
U33589OtherFIRST PLAN
MN611825900Medicaid
U33589OtherEYE MED
3C838SCOtherBLUE SHIELD
974251008835OtherPREFERRED ONE
0842720001Medicare NSC