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NPI Code Detail

MEDICARE: MR. JAMES L SCHMONSKY III OD

MEDICARE: MR. JAMES L SCHMONSKY III 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
1152W00000XOptometrist1643-035WI

Other Identifiers

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

General Provider Information

NPI Number : 1609896042
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES L SCHMONSKY III OD
Provider Business Mailing Address
First Line : 3498 BUYARSKI RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-9452
Country : US
Telephone Number : 920-863-1763
Fax Number :
Provider Business Practice Location Address
First Line : 2430 E MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54302-3759
Country : US
Telephone Number : 920-468-4642
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 07/08/2007

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