Provider Demographics
NPI:1003967852
Name:SCHLEGEL, STEPHEN K (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:K
Last Name:SCHLEGEL
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 1:7481 OBRIEN LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-2761
Mailing Address - Country:US
Mailing Address - Phone:812-797-1100
Mailing Address - Fax:
Practice Address - Street 1:BMACH
Practice Address - Street 2:6600 VAN AALST BLVD
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:762-408-1217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002924B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200159610Medicaid
INU70925Medicare UPIN