Provider Demographics
NPI:1780766154
Name:SCHEERENS, DEANNA J (OD)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:J
Last Name:SCHEERENS
Suffix:
Gender:F
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:PO BOX 427
Mailing Address - Street 2:MACKINAW CITY
Mailing Address - City:MACKINAW CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49701-0427
Mailing Address - Country:US
Mailing Address - Phone:231-436-2020
Mailing Address - Fax:
Practice Address - Street 1:580 SOUTH NICOLET STREET
Practice Address - Street 2:MACKINAW CITY
Practice Address - City:MACKINAW CITY
Practice Address - State:MI
Practice Address - Zip Code:49701
Practice Address - Country:US
Practice Address - Phone:231-436-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0675740001Medicare NSC
MIU37079Medicare UPIN