Provider Demographics
NPI:1932160231
Name:SCHINDERLE, MARK H (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:SCHINDERLE
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 1:525 W US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49870-1127
Mailing Address - Country:US
Mailing Address - Phone:906-563-5711
Mailing Address - Fax:906-563-9196
Practice Address - Street 1:525 W US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:MI
Practice Address - Zip Code:49870-1127
Practice Address - Country:US
Practice Address - Phone:906-563-5711
Practice Address - Fax:906-563-9196
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3850060Medicaid
MI900B210310OtherBCBS ID #
MI382501645OtherTAX ID #
MI382501645OtherTAX ID #
MI900B210310OtherBCBS ID #
WI3850060Medicaid