Provider Demographics
NPI:1780725309
Name:SCHUBERTH, WILLIAM A (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:SCHUBERTH
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 1:233 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3399
Mailing Address - Country:US
Mailing Address - Phone:815-338-0674
Mailing Address - Fax:815-338-6139
Practice Address - Street 1:233 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3399
Practice Address - Country:US
Practice Address - Phone:815-338-0674
Practice Address - Fax:815-338-6139
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-7127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05684014OtherBCBS
ILT35309OtherHUMANA
IL05684014OtherBCBS
IL206500Medicare ID - Type Unspecified