MEDICARE: MICHAEL ROBERT SCHROEDL 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	TUV004055-1	NY

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	:	1740285840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ROBERT SCHROEDL O.D.

Provider Business Mailing Address
First Line	:	184 DOMAN RD
Second Line	:
City	:	FREEHOLD
State	:	NY
Zip	:	12431-6026
Country	:	US
Telephone Number	:	585-314-6680
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 U.S. ROUTE 9W
Second Line	:
City	:	RAVENA
State	:	NY
Zip	:	12143
Country	:	US
Telephone Number	:	585-728-9890
Fax Number	:	585-728-5188

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/08/2017

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