MEDICARE: MARIE ANN SCHAEFER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6070	OH
2	152W00000X	Optometrist	2939	CO

General Provider Information

NPI Number	:	1386927861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE ANN SCHAEFER O.D.

Provider Business Mailing Address
First Line	:	1580 BLAKE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1322
Country	:	US
Telephone Number	:	303-844-3937
Fax Number	:	303-844-3940

Provider Business Practice Location Address
First Line	:	1580 BLAKE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1322
Country	:	US
Telephone Number	:	303-844-3937
Fax Number	:	303-844-3940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	12/04/2013

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