Provider Demographics
NPI:1669495875
Name:SCHROEDER, JENNIFER L (LDO)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3594 BROADWAY
Mailing Address - Street 2:SUITE H
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8016
Mailing Address - Country:US
Mailing Address - Phone:239-275-7320
Mailing Address - Fax:239-275-7721
Practice Address - Street 1:3594 BROADWAY
Practice Address - Street 2:SUITE H
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8016
Practice Address - Country:US
Practice Address - Phone:239-275-7320
Practice Address - Fax:239-275-7721
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5142156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013340001Medicare ID - Type UnspecifiedOPTICIAN