Provider Demographics
NPI:1104967058
Name:SCHROT, TIMOTHY (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:SCHROT
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 1:506 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4205
Mailing Address - Country:US
Mailing Address - Phone:248-589-8240
Mailing Address - Fax:248-589-2597
Practice Address - Street 1:506 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4205
Practice Address - Country:US
Practice Address - Phone:248-589-8240
Practice Address - Fax:248-589-2597
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU50774Medicare UPIN