MEDICARE: DR. ANN T SCHLAEFER 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	163W00000X	Registered Nurse	77393	WI
2	152W00000X	Optometrist	2518	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410046881	OTHER	WI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	811046	OTHER	WI	NATIONAL VISION ASSOCIATE

General Provider Information

NPI Number	:	1548257728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN T SCHLAEFER O.D.

Provider Business Mailing Address
First Line	:	128 W MAIN ST
Second Line	:
City	:	CAMPBELLSPORT
State	:	WI
Zip	:	53010-2704
Country	:	US
Telephone Number	:	920-533-8426
Fax Number	:	920-533-8380

Provider Business Practice Location Address
First Line	:	128 W MAIN ST
Second Line	:
City	:	CAMPBELLSPORT
State	:	WI
Zip	:	53010-2704
Country	:	US
Telephone Number	:	920-533-8426
Fax Number	:	920-533-8380

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	06/07/2023

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