Provider Demographics
NPI:1982087540
Name:SCHMUCKER, ALEXANDRA (OD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SCHMUCKER
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 1:5655 MONCLOVA RD
Mailing Address - Street 2:STE 2
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1870
Mailing Address - Country:US
Mailing Address - Phone:419-893-4883
Mailing Address - Fax:419-893-2312
Practice Address - Street 1:3000 REGENCY CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3092
Practice Address - Country:US
Practice Address - Phone:419-882-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist