Healthcare Provider Details

I. General information

NPI: 1295967172
Provider Name (Legal Business Name): RALPH HERMAN SCHNEIDER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 THELMA DR
SAN ANTONIO TX
78212-2455
US

IV. Provider business mailing address

508 THELMA DR
SAN ANTONIO TX
78212-2455
US

V. Phone/Fax

Practice location:
  • Phone: 210-820-3450
  • Fax: 210-804-0454
Mailing address:
  • Phone: 210-820-3450
  • Fax: 210-804-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1937GT
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1340
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: