Provider Demographics
NPI:1548257728
Name:SCHLAEFER, ANN T (OD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:T
Last Name:SCHLAEFER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSPORT
Mailing Address - State:WI
Mailing Address - Zip Code:53010-2704
Mailing Address - Country:US
Mailing Address - Phone:920-533-8426
Mailing Address - Fax:920-533-8380
Practice Address - Street 1:128 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSPORT
Practice Address - State:WI
Practice Address - Zip Code:53010-2704
Practice Address - Country:US
Practice Address - Phone:920-533-8426
Practice Address - Fax:920-533-8380
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI77393163W00000X
WI2518152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI410046881OtherRAILROAD MEDICARE
WI38586400Medicaid
WI811046OtherNATIONAL VISION ASSOCIATE
WI811046OtherNATIONAL VISION ASSOCIATE
WI410046881OtherRAILROAD MEDICARE
WI6165100001Medicare NSC