Healthcare Provider Details

I. General information

NPI: 1235220179
Provider Name (Legal Business Name): KENT R SCHAUER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 MORRIS ST NE SUITE A
ALBUQUERQUE NM
87111-3605
US

IV. Provider business mailing address

4101 MORRIS ST NE SUITE A
ALBUQUERQUE NM
87111-3605
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-4426
  • Fax: 505-299-3746
Mailing address:
  • Phone: 505-299-4426
  • Fax: 505-299-3746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number221
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: