Basic Information
| Provider Information | |||||||||
| NPI: | 1982659934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHNEIDER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4452 EASTGATE BLVD | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452451584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137525700 | ||||||||
| FaxNumber: | 5137525716 | ||||||||
| Practice Location | |||||||||
| Address1: | 4452 EASTGATE BLVD | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452451584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137525700 | ||||||||
| FaxNumber: | 5137525716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 03/30/2009 | ||||||||
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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 | 207W00000X | 35-038614 | OH | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 29018 | KY | N | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 36000917 | 05 | OH | MEDICAID | 36000925 | 05 | OH | MEDICAID | 64930530 | 05 | KY | MEDICAID | 65921157 | 05 | OH | MEDICAID | 0502656 | 05 | OH | MEDICAID | 65928707 | 05 | OH | MEDICAID | 65945511 | 05 | KY | MEDICAID |