Provider Demographics
NPI:1528049012
Name:SCHROEDER, RICHARD JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5035
Mailing Address - Country:US
Mailing Address - Phone:970-259-1789
Mailing Address - Fax:970-259-0810
Practice Address - Street 1:1845 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5035
Practice Address - Country:US
Practice Address - Phone:970-259-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003425152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS410029857OtherRAILROAD MEDICARE
KS100218930AMedicaid
005078OtherBCBS
KSU05566Medicare UPIN
KS005078Medicare PIN