Provider Demographics
NPI:1255387684
Name:SCHROEDL, BRIAN L (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:SCHROEDL
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 1:889 WARNER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1263
Mailing Address - Country:US
Mailing Address - Phone:920-623-1118
Mailing Address - Fax:
Practice Address - Street 1:822 PARK AVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2266
Practice Address - Country:US
Practice Address - Phone:920-887-3791
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12055900Medicaid
WIT36502Medicare UPIN