Healthcare Provider Details

I. General information

NPI: 1396827903
Provider Name (Legal Business Name): PRISCILLA RAE SCHAEFFER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 BELMONT AVE
YOUNGSTOWN OH
44505-2401
US

IV. Provider business mailing address

2031 BELMONT AVE
YOUNGSTOWN OH
44505-2401
US

V. Phone/Fax

Practice location:
  • Phone: 330-740-9200
  • Fax:
Mailing address:
  • Phone: 330-740-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5570/T2484
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: