Provider Demographics
NPI:1851603310
Name:SCHAFER, EMILY MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MARIE
Last Name:SCHAFER
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 1:1700 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2779
Mailing Address - Country:US
Mailing Address - Phone:269-342-0003
Mailing Address - Fax:
Practice Address - Street 1:29474 WEST SEVEN MILE ROAD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:248-615-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1772003Medicare PIN
MIN26930209Medicare PIN
MI0C97655Medicare PIN