Individual
DR. KENNETH A SCHAIDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4620 N UNIVERSITY ST, PEORIA, IL 61614-5889
(309) 692-8222
(309) 692-8226
Mailing address
8309 N KNOXVILLE AVE, PEORIA, IL 61615-2170
(309) 693-9540
(309) 693-9542
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008408
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008408
—
IL
01
—
410033418
MEDICARE RAILROAD
IL
01
—
7215175
BCBS
IL
Enumeration date
09/29/2005
Last updated
01/10/2014
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