Provider Demographics
NPI:1790462547
Name:SCHAEDEL, KELLI (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:
Last Name:SCHAEDEL
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 1:1127 S GUTENSOHN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5228
Mailing Address - Country:US
Mailing Address - Phone:479-750-3937
Mailing Address - Fax:
Practice Address - Street 1:1127 S GUTENSOHN RD STE 1
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5228
Practice Address - Country:US
Practice Address - Phone:479-750-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2868152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist