Basic Information
| Provider Information | |||||||||
| NPI: | 1003835778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHNEIDER | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 S UNIVERSITY AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BEAVER DAM | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539163053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208871151 | ||||||||
| FaxNumber: | 9208873353 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 S UNIVERSITY AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BEAVER DAM | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539163053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208871151 | ||||||||
| FaxNumber: | 9208873353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1413 | WI | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 1006595 | 01 | WI | PHYSICIANS PLUS HMO | OTHER | 410032599 | 01 | WI | RAIL ROAD MEDICARE | OTHER | 10365 | 01 | WI | CEAN CARE HMO | OTHER | 38562000 | 05 | WI | MEDICAID | WI0117 | 01 | JOHN DEERE HEALTH PLAN | OTHER | 39115615603 | 01 | WI | UNITY HMO | OTHER | 391156156 | 01 | TAX ID | OTHER | 12233 | 01 | WI | NETWORK HEALTH PLAN | OTHER |