Samuel Jack Shroder, OD - Medicare Optometrist in Fairborn, OH

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Samuel Jack Shroder, OD is a medicare enrolled "Optometrist" provider in Fairborn, Ohio. He went to Ohio State University - College Of Optometry and graduated in 2026 and has 0 years of diverse experience with area of expertise as Optometry. He is a member of the group practice Vision Center Ltd and his current practice location is 1790 Commerce Center Blvd, Fairborn, Ohio. You can reach out to his office (for appointments etc.) via phone at (937) 878-3941.

Samuel Jack Shroder is licensed to practice in Ohio (license number OPT.007484) and he also participates in the medicare program. He may accept medicare assignments (which means he may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and his NPI Number is 1124982368.

Contact Information

Samuel Jack Shroder, OD
1790 Commerce Center Blvd,
Fairborn, OH 45324-6358
(937) 878-3941
Not Available

Map and Direction




Healthcare Provider's Profile

Full NameSamuel Jack Shroder
GenderMale
SpecialityOptometry
Location1790 Commerce Center Blvd, Fairborn, Ohio
Accepts Medicare AssignmentsMay be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Samuel Jack Shroder attended and graduated from Ohio State University - College Of Optometry in 2026
  NPI Data:
  • NPI Number: 1124982368
  • Provider Enumeration Date: 12/11/2025
  • Last Update Date: 05/18/2026
  Medicare PECOS Information:
  • PECOS PAC ID: 4688145931
  • Enrollment ID: I20260611000365

Medical Identifiers

Medical identifiers for Samuel Jack Shroder such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1124982368NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
152W00000XOptometrist OPT.007484 (Ohio)Primary

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Vision Center Ltd72149142823

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Samuel Jack Shroder allows following entities to bill medicare on his behalf.
Provider NameVision Center Ltd
Provider TypePart B Supplier - Clinic/group Practice
Provider IdentifiersNPI Number: 1417034133
PECOS PAC ID: 7214914282
Enrollment ID: O20040707000909

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Samuel Jack Shroder is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Samuel Jack Shroder, OD
1790 Commerce Center Blvd,
Fairborn, OH 45324-6358

Ph: (937) 878-3941		Samuel Jack Shroder, OD
1790 Commerce Center Blvd,
Fairborn, OH 45324-6358

Ph: (937) 878-3941

Reviews and Comments


Optometrist in Fairborn, OH

Dr. Jerry L Neely, OD
Optometrist
Medicare: Not Enrolled in Medicare
Practice Location: 1790 Commerce Center Blvd, Fairborn, OH 45324
Phone: 937-878-3941    Fax: 937-878-3525
Dr. Elizabeth A Snyder, OD
Optometrist
Medicare: May Accept Medicare Assignments
Practice Location: 1790 Commerce Center Blvd, Fairborn, OH 45324
Phone: 937-878-3941    Fax: 937-878-3525
The Fairborn Vision Center
Optometrist
Medicare: Medicare Enrolled
Practice Location: 1790 Commerce Center Blvd, Fairborn, OH 45324
Phone: 937-878-3941    
Dr. Steven W Shroder, OD
Optometrist
Medicare: May Accept Medicare Assignments
Practice Location: 1790 Commerce Center Blvd, Fairborn, OH 45324
Phone: 937-878-3941    Fax: 937-878-3525
Dapore Vision Care Llc
Optometrist
Medicare: Not Enrolled in Medicare
Practice Location: 1877 S Maple Ave, Suite 100, Fairborn, OH 45324
Phone: 937-878-8800    Fax: 937-878-8802

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.