Provider Demographics
NPI:1891846242
Name:SCHLEGEL, REX S (OD)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:S
Last Name:SCHLEGEL
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 1:725 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:IN
Mailing Address - Zip Code:47446-1414
Mailing Address - Country:US
Mailing Address - Phone:812-849-4555
Mailing Address - Fax:812-849-2842
Practice Address - Street 1:725 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:IN
Practice Address - Zip Code:47446-1414
Practice Address - Country:US
Practice Address - Phone:812-849-4555
Practice Address - Fax:812-849-2842
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001391B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN965820Medicare ID - Type Unspecified
INT35234Medicare UPIN