Provider Demographics
NPI:1790735801
Name:SCHAUER, TRACY J (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:J
Last Name:SCHAUER
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 1:1421 50TH ST NE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-3640
Mailing Address - Country:US
Mailing Address - Phone:763-682-4570
Mailing Address - Fax:763-295-4701
Practice Address - Street 1:504 PINE ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8570
Practice Address - Country:US
Practice Address - Phone:763-295-0004
Practice Address - Fax:763-295-4701
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN271977100Medicaid
MN271977100Medicaid
MN410002096Medicare ID - Type Unspecified