Provider Demographics
NPI:1538122924
Name:SCHRAM, NEIL I (OD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:I
Last Name:SCHRAM
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 1:175 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3222
Mailing Address - Country:US
Mailing Address - Phone:617-242-3577
Mailing Address - Fax:617-241-5293
Practice Address - Street 1:175 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3222
Practice Address - Country:US
Practice Address - Phone:617-242-3577
Practice Address - Fax:617-241-5293
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2319152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0314706Medicaid
MA0314706Medicaid
128658Medicare ID - Type Unspecified