Healthcare Provider Details

I. General information

NPI: 1154557817
Provider Name (Legal Business Name): SCHLAEFER OPTOMETRISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W MAIN ST.
CAMPBELLSPORT WI
53010
US

IV. Provider business mailing address

128 W MAIN ST. P.O. BOX 209
CAMPBELLSPORT WI
53010
US

V. Phone/Fax

Practice location:
  • Phone: 920-533-8426
  • Fax: 920-533-8380
Mailing address:
  • Phone: 920-533-8426
  • Fax: 920-533-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANN THERESE SCHLAEFER
Title or Position: OWNER
Credential: OD
Phone: 920-533-8426