MEDICARE: DR. JEFFREY G SCHMAKEL 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	3372-T967	OH
2	152WC0802X	Corneal and Contact Management Optometrist	3372-T967	OH
3	152WL0500X	Low Vision Rehabilitation Optometrist	3372-T967	OH
4	152WP0200X	Pediatric Optometrist	3372-T967	OH
5	152WS0006X	Sports Vision Optometrist	3372-T967	OH
6	152WV0400X	Vision Therapy Optometrist	3372-T967	OH
7	152WX0102X	Occupational Vision Optometrist	3372-T967	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	341897615	OTHER	OH	TAX ID # OD PRACTICE
2	201624211	OTHER	OH	VIP TAX ID#
3	3372-T967	OTHER	OH	OPTOMETRIC LICENSE#
4	000000141689	OTHER	OH	ANTHEM BC/BS ID#
5	03220	OTHER	OH	PARAMOUNT INSURANCE ID#
6	1119160001	OTHER	OH	DMERC ID#
7	116749	OTHER	OH	EYEMED/ECPA ID #

General Provider Information

NPI Number	:	1750310371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY G SCHMAKEL O.D.

Provider Business Mailing Address
First Line	:	2237 KINGSTON DR
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-1122
Country	:	US
Telephone Number	:	419-867-1819
Fax Number	:

Provider Business Practice Location Address
First Line	:	3454 OAK ALLEY CT
Second Line	:	STE 202
City	:	TOLEDO
State	:	OH
Zip	:	43606-1370
Country	:	US
Telephone Number	:	419-578-0057
Fax Number	:	419-578-0061

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	12/30/2009

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