Provider Demographics
NPI:1972811321
Name:SCHILAWSKI, MICHAEL SUTTON (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SUTTON
Last Name:SCHILAWSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818B PINE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-5600
Mailing Address - Country:US
Mailing Address - Phone:910-793-2010
Mailing Address - Fax:
Practice Address - Street 1:201 RACINE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8702
Practice Address - Country:US
Practice Address - Phone:910-395-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916303Medicaid
NC0932POtherBCBS
NC2844661Medicare PIN