Provider Demographics
NPI:1780336057
Name:SCHOEN, ALEX J (OD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:J
Last Name:SCHOEN
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 1:1507 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1301
Mailing Address - Country:US
Mailing Address - Phone:715-735-9593
Mailing Address - Fax:
Practice Address - Street 1:1507 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1301
Practice Address - Country:US
Practice Address - Phone:715-735-9593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005601152W00000X
WI3753-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist