Provider Demographics
NPI:1972685832
Name:SCHILLIG, LAURA B (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:SCHILLIG
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 1:8158 S SUNNY HORIZON PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5522
Mailing Address - Country:US
Mailing Address - Phone:520-207-8906
Mailing Address - Fax:
Practice Address - Street 1:5870 E BROADWAY BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3914
Practice Address - Country:US
Practice Address - Phone:520-745-0770
Practice Address - Fax:520-745-2392
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1331152W00000X
OH5415152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U97486Medicare UPIN