Provider Demographics
NPI:1760470470
Name:SCHAPERKOTTER, THOMAS JOHN (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:SCHAPERKOTTER
Suffix:
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 1:6795 US 31 S
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9701
Mailing Address - Country:US
Mailing Address - Phone:231-547-4486
Mailing Address - Fax:231-547-6668
Practice Address - Street 1:6795 US 31 S
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9701
Practice Address - Country:US
Practice Address - Phone:231-547-4486
Practice Address - Fax:231-547-6668
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002508152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900A56502OtherBLUE CROSS BLUE SHIELD
410023002OtherPALMETTO GBA - RAILROAD MEDICARE
0A56502Medicare PIN
410023002OtherPALMETTO GBA - RAILROAD MEDICARE
OA56502Medicare ID - Type Unspecified