Healthcare Provider Details

I. General information

NPI: 1417886920
Provider Name (Legal Business Name): KIMBERLY ANN SCHLEGEL LDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GOLDIE RD
YOUNGSTOWN OH
44505-1948
US

IV. Provider business mailing address

200 GOLDIE RD
YOUNGSTOWN OH
44505-1948
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-2545
  • Fax: 330-759-2545
Mailing address:
  • Phone: 330-759-2545
  • Fax: 330-759-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.007231-SC
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: