Samuel Jack Shroder, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT.007484 Issued in OH

Practice address

1790 Commerce Center Blvd
Fairborn, OH 45324-6358

Phone

(937) 878-3941

NPI assigned

Dec 11, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Ohio State University - College of Optometry, 2026

Medicare assignment

May accept Medicare assignment

Group practices

Vision Center LTDGroup PAC ID 7214914282, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vision Center LTD

  • Optometrist
  • Fairborn, OH
  • NPI 1417034133
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1765411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1124982368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 COMMERCE CENTER BLVD",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453246358",
            "telephone_number": "937-878-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 COMMERCE CENTER BLVD",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453246358",
            "telephone_number": "937-878-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHRODER",
        "first_name": "SAMUEL",
        "middle_name": "JACK",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-12-11",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "OPT.007484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashton Shellabarger
• Kathryn Sherer
• Hannah Shirley
• Amber Short
• Taelur Shorter
• Steven W Shroder, OD
• Kelly A Sierra, M.S., PC
• Sigmedics, Inc.
• Issouf Sigue
• Lisa Sikorski, LSW

• Optometrist in Fairborn, OH
• Providers in Fairborn, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.