Provider Demographics
NPI:1790097343
Name:SCHERMEISTER, KELLY LYN (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYN
Last Name:SCHERMEISTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:LYN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:14320 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-7036
Mailing Address - Country:US
Mailing Address - Phone:262-786-2020
Mailing Address - Fax:262-786-1615
Practice Address - Street 1:14320 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-7036
Practice Address - Country:US
Practice Address - Phone:262-786-2020
Practice Address - Fax:262-786-1615
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3185152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI475800006Medicare PIN