Provider Demographics
NPI:1215093760
Name:SCHLETER, HARVEY A (OD PSC)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:A
Last Name:SCHLETER
Suffix:
Gender:M
Credentials:OD PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 E.MT.VERNON STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501
Mailing Address - Country:US
Mailing Address - Phone:606-679-5177
Mailing Address - Fax:606-678-9200
Practice Address - Street 1:709 E MT VERNON ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-679-5177
Practice Address - Fax:606-678-9200
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY960DT152W00000X
IN18001993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77009603Medicaid
KY77009603Medicaid
KYT54693Medicare UPIN
KY0136740001Medicare NSC