Provider Demographics
NPI:1386610657
Name:SCHWADERER, KENNETH N (OD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:N
Last Name:SCHWADERER
Suffix:
Gender:M
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:495 CASTRO ST
Mailing Address - Street 2:MOUNTAIN VIEW OPTOMETRY & CONTACT LENS CLINIC
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-2086
Mailing Address - Country:US
Mailing Address - Phone:650-967-6649
Mailing Address - Fax:650-967-0237
Practice Address - Street 1:495 CASTRO ST
Practice Address - Street 2:MOUNTAIN VIEW OPTOMETRY & CONTACT LENS CLINIC
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-2086
Practice Address - Country:US
Practice Address - Phone:650-967-6649
Practice Address - Fax:650-967-0237
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA5331TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0053310Medicare PIN
CAT09953Medicare UPIN