Provider Demographics
NPI:1831225051
Name:SCHLETTER, PHILIP (OD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:SCHLETTER
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 1:1799 4TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1741
Mailing Address - Country:US
Mailing Address - Phone:510-559-9581
Mailing Address - Fax:510-559-9581
Practice Address - Street 1:1799 4TH ST STE E
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1741
Practice Address - Country:US
Practice Address - Phone:510-559-9581
Practice Address - Fax:510-559-9581
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist