Provider Demographics
NPI:1154329100
Name:SCHROEDER, BARBARA (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5529
Mailing Address - Country:US
Mailing Address - Phone:260-422-3937
Mailing Address - Fax:260-424-6900
Practice Address - Street 1:3301 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5529
Practice Address - Country:US
Practice Address - Phone:260-422-3937
Practice Address - Fax:260-424-6900
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039063A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN180011187OtherRR MEDICARE
IN100348030Medicaid
IN137440BMedicare PIN
INE84912Medicare UPIN