Healthcare Provider Details

I. General information

NPI: 1760470470
Provider Name (Legal Business Name): THOMAS JOHN SCHAPERKOTTER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6795 US 31 S
CHARLEVOIX MI
49720-9701
US

IV. Provider business mailing address

6795 US 31 S
CHARLEVOIX MI
49720-9701
US

V. Phone/Fax

Practice location:
  • Phone: 231-547-4486
  • Fax: 231-547-6668
Mailing address:
  • Phone: 231-547-4486
  • Fax: 231-547-6668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002508
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: