Healthcare Provider Details

I. General information

NPI: 1205817970
Provider Name (Legal Business Name): KIRK ROBERT SCHOTT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20312 HIGHWAY M-28 WEST SUITE C
EWEN MI
49925
US

IV. Provider business mailing address

PO BOX 254
BRUCE CROSSING MI
49912-0254
US

V. Phone/Fax

Practice location:
  • Phone: 906-988-2752
  • Fax: 906-988-2753
Mailing address:
  • Phone: 906-827-3559
  • Fax: 906-827-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberL706042
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: