Provider Demographics
NPI:1144495276
Name:KIRK R. SCHOTT, O.D., P.C.
Entity type:Organization
Organization Name:KIRK R. SCHOTT, O.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:906-353-8100
Mailing Address - Street 1:805 US HIGHWAY 41 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:BARAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49908-9669
Mailing Address - Country:US
Mailing Address - Phone:906-353-8100
Mailing Address - Fax:906-353-8101
Practice Address - Street 1:805 US HIGHWAY 41 S
Practice Address - Street 2:SUITE A
Practice Address - City:BARAGA
Practice Address - State:MI
Practice Address - Zip Code:49908-9669
Practice Address - Country:US
Practice Address - Phone:906-353-8100
Practice Address - Fax:906-353-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION20060Medicare PIN
MI23849Medicare UPIN
MI4479350001Medicare NSC