Provider Demographics
NPI:1871769646
Name:JOHN W. SCHAEFER, O.D.
Entity type:Organization
Organization Name:JOHN W. SCHAEFER, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-847-6264
Mailing Address - Street 1:205 DIVISION ST.
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-2109
Mailing Address - Country:US
Mailing Address - Phone:608-847-6264
Mailing Address - Fax:608-847-7279
Practice Address - Street 1:205 DIVISION ST.
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-2109
Practice Address - Country:US
Practice Address - Phone:608-847-6264
Practice Address - Fax:608-847-7279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38516200Medicaid
WI0244500001Medicare NSC
T63200Medicare UPIN
WI38516200Medicaid