Provider Demographics
NPI:1801847306
Name:SCHAUFFELE, HEIDI (OD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:SCHAUFFELE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:SCHAUFFELE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3704 MARCONI AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5338
Mailing Address - Country:US
Mailing Address - Phone:916-971-3937
Mailing Address - Fax:916-971-0872
Practice Address - Street 1:3704 MARCONI AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5338
Practice Address - Country:US
Practice Address - Phone:916-971-3937
Practice Address - Fax:916-971-0872
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12414T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU97721Medicare UPIN
CASD0124140Medicare ID - Type Unspecified