Provider Demographics
NPI:1740203025
Name:TYLER L SCHREMMER OD PA
Entity type:Organization
Organization Name:TYLER L SCHREMMER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHREMMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-653-2749
Mailing Address - Street 1:801 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:HOISINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67544-1847
Mailing Address - Country:US
Mailing Address - Phone:620-653-2749
Mailing Address - Fax:620-653-4508
Practice Address - Street 1:801 N PINE ST
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1847
Practice Address - Country:US
Practice Address - Phone:620-653-2749
Practice Address - Fax:620-653-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1409-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS410047431OtherRAILROAD MEDICARE
KS100327830CMedicaid
KS650541OtherBCBS
KS650541OtherBCBS
KS410047431OtherRAILROAD MEDICARE
KS650541Medicare PIN