Provider Demographics
NPI:1063525780
Name:SCHAEDLER, MATTHEW J (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:SCHAEDLER
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 1:915 OLD FERN HILL RD
Mailing Address - Street 2:BUILDING B, SUITE 200
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4269
Mailing Address - Country:US
Mailing Address - Phone:610-696-1230
Mailing Address - Fax:610-696-2341
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:BUILDING B, SUITE 200
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-696-1230
Practice Address - Fax:610-696-2341
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE13-0001276152W00000X
PAOEG002689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00016OtherMEDICARE GROUP PIN
DE110998OtherEYEMED
DE11220816OtherCAQH
DE161525705OtherBCBS
DE1000022556Medicaid
DE7383169OtherAETNA
DEU83866Medicare UPIN
DE11220816OtherCAQH
DEG00016OtherMEDICARE GROUP PIN