=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407629033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHAEFER OCULOFACIAL PLASTIC SURGERY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2023
-----------------------------------------------------
Last Update Date | 11/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 SUMMER ST STE 300
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14209-2256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-479-8489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 467 HAMMOCKS DR
-----------------------------------------------------
City | ORCHARD PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14127-1685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-479-8489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPHTHALMOLOGIST / OWNER
-----------------------------------------------------
Name | DR. JAMIE LEA SCHAEFER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 716-479-8489
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207WX0200X
-----------------------------------------------------
Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------