Provider Demographics
NPI:1679578165
Name:SCHNEIDER, JILL A (OD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:SCHNEIDER
Suffix:
Gender:F
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69363-0008
Mailing Address - Country:US
Mailing Address - Phone:308-632-2020
Mailing Address - Fax:308-635-3641
Practice Address - Street 1:1930 E 20TH PL
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-2708
Practice Address - Country:US
Practice Address - Phone:308-632-2020
Practice Address - Fax:308-635-3641
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1084 / 253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE410048689OtherPALMETTO GBA RAILROAD
NE239736OtherMIDLANDS CHOICE
NE06705OtherBLUE CROSS/ BLUE SHIELD
NE06705OtherBLUE CROSS/ BLUE SHIELD