Provider Demographics
NPI:1700928264
Name:SCHALLER, STEVEN G (LDO)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:G
Last Name:SCHALLER
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25360 THOMPSON ROAD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-9360
Mailing Address - Country:US
Mailing Address - Phone:419-874-4226
Mailing Address - Fax:419-874-4725
Practice Address - Street 1:3333 GLENDALE AVENUE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614
Practice Address - Country:US
Practice Address - Phone:419-259-2000
Practice Address - Fax:419-259-2008
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC-4955156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4795750001Medicare ID - Type Unspecified