MEDICARE: RICHARD CHARLES SCHLIEVERT OD

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	OPT002529	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467687012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD CHARLES SCHLIEVERT OD

Provider Business Mailing Address
First Line	:	2275 MARIETTA BLVD NW STE 270-314
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2004
Country	:	US
Telephone Number	:	678-438-5612
Fax Number	:	678-623-3633

Provider Business Practice Location Address
First Line	:	2275 MARIETTA BLVD NW # 270-314
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2004
Country	:	US
Telephone Number	:	678-438-5612
Fax Number	:	678-623-3633

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

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	04/08/2022

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