Active NPI
Michael Robert Schroedl, O.D.
- Optometrist
- Ravena, NY
National Provider Identifier
1740285840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TUV004055-1
- Practice address
- 2840 U.S. Route 9W
Ravena, NY 12143 - Phone
- (585) 728-9890
- Fax
- (585) 728-5188
- NPI assigned
- Jun 15, 2005
- Last updated
- Nov 8, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV004055-1 | NY | Primary |
Addresses
Primary practice location
2840 U.S. Route 9W
Ravena, NY 12143
Mailing address
184 Doman Rd
Freehold, NY 12431-6026
Phone (585) 314-6680
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00879314 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TUV004055-1 | NY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wayland Optometric | Past | Accepting new patients | |
| Wayland Management, Inc. | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Eyewear Supplier
- Wayland, NY
- NPI 1720257900
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510099200000",
"number": "1740285840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "184 DOMAN RD",
"city": "FREEHOLD",
"state": "NY",
"postal_code": "124316026",
"telephone_number": "585-314-6680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2840 U.S. ROUTE 9W",
"city": "RAVENA",
"state": "NY",
"postal_code": "12143",
"telephone_number": "585-728-9890",
"fax_number": "585-728-5188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHROEDL",
"first_name": "MICHAEL",
"middle_name": "ROBERT",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-15",
"last_updated": "2017-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV004055-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00879314",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ravena, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.