SAMUEL JACK SHRODER OD
NPI 1124982368
Optometrist in Fairborn, OH

Q: What is Samuel Shroder's NPI number?

The NPI number for Samuel Shroder is 1124982368. It was assigned to this individual provider in the NPPES registry on December 11, 2025.

Q: What is Samuel Shroder's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Q: When was this NPI record last updated?

The NPPES record for Samuel Shroder was last updated on May 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 11, 2025PECOS Enrolled

1790 COMMERCE CENTER BLVD, FAIRBORN, OH 45324(937) 878-3941 Get Directions Write a Review

NPPES record last updated: May 18, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 18, 2026, Dec 11, 2025 (2 updates tracked since 2025).

On this page

About Samuel Jack Shroder Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMUEL JACK SHRODER OD (NPI 1124982368) is an individual optometrist in Fairborn, Ohio, licensed in Ohio (OPT.007484) and active in the NPI registry since December 2025. He is enrolled in Medicare PECOS and is a graduate of Ohio State University - College Of Optometry (2026).

NPPES Registry Identity

NPI1124982368

Entity TypeIndividualMale

Primary Taxonomy152W00000X

Provider Legal NameSAMUEL JACK SHRODERCredential: OD

Location Address1790 COMMERCE CENTER BLVDFairborn, OH 45324-6358

Mailing Address1790 Commerce Center BlvdFairborn, OH 45324-6358 · (937) 878-3941

Phone(937) 878-3941

Sole ProprietorNo

Medical School CMSOhio State University - College Of OptometryGraduated 2026

Enumeration DateDecember 11, 2025

Last NPPES UpdateMay 18, 20262 updates tracked since enumeration

NPPES CertifiedMay 18, 2026

✔ NPI 1124982368 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

License✔ Licensed in OH · OPT.007484

Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

1790 COMMERCE CENTER BLVD, Fairborn, OH 45324

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel Jack Shroder Od is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4688145931

PECOS Enrollment IDI20260611000365

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Samuel Shroder reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Vision Center Ltd

Same address

Optometrist

1790 COMMERCE CENTER BLVD
Fairborn, OH 45324

Reassigned Medicare billing, Ohio enrollment
3 clinicians in this Medicare group

NPI 1417034133 (937) 878-3941

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45324 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$126.12 typical visit price

range $54.34 – $166.65

Typical copayment $31.53 (range $13.58 – $41.66)

Most-billed visit code 99204

Established Patient

$68.07 typical visit price

range $17.10 – $135.40

Typical copayment $17.01 (range $4.27 – $33.85)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JERRY L NEELY OD

Optometrist

1790 COMMERCE CENTER BLVD
FAIRBORN, OH 45324

Greene County (937) 878-3941

DR. ELIZABETH A SNYDER OD

Optometrist

1790 COMMERCE CENTER BLVD
FAIRBORN, OH 45324

Greene County (937) 878-3941

VISION CENTER LTD

Optometrist

1790 COMMERCE CENTER BLVD
FAIRBORN, OH 45324

Greene County (937) 878-3941

DR. STEVEN W SHRODER OD

Optometrist

1790 COMMERCE CENTER BLVD
FAIRBORN, OH 45324

Greene County (937) 878-3941

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel Shroder's NPI number?

The NPI number for Samuel Shroder is 1124982368. It was assigned to this individual provider in the NPPES registry on December 11, 2025.

Where is Samuel Shroder located?

Samuel Shroder practices at 1790 Commerce Center Blvd, Fairborn, OH 45324. The listed phone number is (937) 878-3941.

What is Samuel Shroder's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Samuel Shroder enrolled in Medicare?

Yes. Samuel Shroder is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Samuel Shroder's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Shroder reassigns Medicare benefits to Vision Center Ltd (Fairborn, OH). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samuel Shroder's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Samuel Shroder accept?

Health plans from Anthem Blue Cross and Blue Shield and Providence Health Plan list Samuel Shroder as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Samuel Shroder was last updated on May 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.