Provider Demographics
NPI:1831194927
Name:MASCHAUER, CARL (OD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:MASCHAUER
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:PO BOX 5991
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5991
Mailing Address - Country:US
Mailing Address - Phone:340-773-2020
Mailing Address - Fax:
Practice Address - Street 1:4500 SUNNY ISLE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4493
Practice Address - Country:US
Practice Address - Phone:302-381-2696
Practice Address - Fax:340-778-0977
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI52152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000025522Medicaid
DE0075199000OtherAMERIHEALTH
DE058273S30Medicare PIN
DE580002510Medicare PIN
VIH1198ZMedicare UPIN
DE0924150001Medicare NSC
T26888Medicare UPIN