Provider Demographics
NPI:1720150824
Name:SCHOMAKER, SCOTT L (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:SCHOMAKER
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 1:26 S MAIN
Mailing Address - Street 2:P.O. BOX 683
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8936
Mailing Address - Country:US
Mailing Address - Phone:616-696-0830
Mailing Address - Fax:616-696-4724
Practice Address - Street 1:26 S MAIN
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8936
Practice Address - Country:US
Practice Address - Phone:616-696-0830
Practice Address - Fax:616-696-4724
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3403115Medicaid
MION83040Medicare ID - Type Unspecified
MI3403115Medicaid