Provider Demographics
NPI:1295797421
Name:DOUGLAS SCHNEIDER OD PC
Entity type:Organization
Organization Name:DOUGLAS SCHNEIDER OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-775-6555
Mailing Address - Street 1:1933 N MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1139
Mailing Address - Country:US
Mailing Address - Phone:231-775-6555
Mailing Address - Fax:231-775-6648
Practice Address - Street 1:1933 N MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1139
Practice Address - Country:US
Practice Address - Phone:231-775-6555
Practice Address - Fax:231-775-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1500559Medicaid
T33811Medicare UPIN
MI1500559Medicaid
MI1240000001Medicare NSC