Provider Demographics
NPI:1740285840
Name:SCHROEDL, MICHAEL ROBERT (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
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 1:184 DOMAN RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:12431-6026
Mailing Address - Country:US
Mailing Address - Phone:585-314-6680
Mailing Address - Fax:
Practice Address - Street 1:2840 U.S. ROUTE 9W
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143
Practice Address - Country:US
Practice Address - Phone:585-728-9890
Practice Address - Fax:585-728-5188
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004055-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00879314Medicaid
NYU19465Medicare UPIN
NYCC9786Medicare ID - Type Unspecified
NY00879314Medicaid