Provider Demographics
NPI:1538330915
Name:KIRK ROBERT SCHOTT
Entity Type:Organization
Organization Name:KIRK ROBERT SCHOTT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SCHOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:906-988-2752
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:BRUCE CROSSING
Mailing Address - State:MI
Mailing Address - Zip Code:49912-0254
Mailing Address - Country:US
Mailing Address - Phone:906-988-2752
Mailing Address - Fax:906-988-2753
Practice Address - Street 1:20312 STATE HIGHWAY M28
Practice Address - Street 2:SUITE C
Practice Address - City:EWEN
Practice Address - State:MI
Practice Address - Zip Code:49925-9082
Practice Address - Country:US
Practice Address - Phone:906-988-2752
Practice Address - Fax:906-988-2753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1143603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0195940002Medicare NSC