Provider Demographics
NPI:1659360014
Name:SCHLICHTEMEIER, WILLIAM R
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:SCHLICHTEMEIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13923 GOLD CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2318
Mailing Address - Country:US
Mailing Address - Phone:402-558-2211
Mailing Address - Fax:402-558-3456
Practice Address - Street 1:13923 GOLD CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2318
Practice Address - Country:US
Practice Address - Phone:402-558-2211
Practice Address - Fax:402-558-3456
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14401207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0904870Medicaid
NE47069906200Medicaid
NE095144Medicare ID - Type Unspecified
IA06864Medicare ID - Type Unspecified
IA0904870Medicaid
NE180004144Medicare ID - Type Unspecified