Healthcare Provider Details

I. General information

NPI: 1740285840
Provider Name (Legal Business Name): MICHAEL ROBERT SCHROEDL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 U.S. ROUTE 9W
RAVENA NY
12143
US

IV. Provider business mailing address

184 DOMAN RD
FREEHOLD NY
12431-6026
US

V. Phone/Fax

Practice location:
  • Phone: 585-728-9890
  • Fax: 585-728-5188
Mailing address:
  • Phone: 585-314-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004055-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: