Provider Demographics
NPI:1609896042
Name:SCHMONSKY, JAMES L III (OD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:SCHMONSKY
Suffix:III
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 1:3498 BUYARSKI RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-9452
Mailing Address - Country:US
Mailing Address - Phone:920-863-1763
Mailing Address - Fax:
Practice Address - Street 1:2430 E MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-3759
Practice Address - Country:US
Practice Address - Phone:920-468-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1643-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38403100Medicaid
WI38403100Medicaid
WI30930Medicare UPIN