Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Samuel Jack Shroder, OD

Individual provider Optometrist · NPI 1124982368

Samuel Jack Shroder, OD is an Optometry in Fairborn, Ohio. Graduated from Ohio State University - College of Optometry in 2026. Licensed in Ohio.

Trained at
Ohio State University - College of Optometry
Licensed in
OH
In the registry since
2025
What do these letters mean?
OD — Doctor of Optometry
An optometrist: examines eyes, prescribes glasses and contacts, and treats many eye conditions.

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Practice location Address checks out

1790 Commerce Center Blvd
Fairborn, OH 45324-6358
Phone: (937) 878-3941
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence OPT.007484 (OH)

Record details

NPI number1124982368
Entity typeIndividual (Type 1)
GenderMale
Credentials OD
Sole proprietorNo
NPI enumeratedDecember 11, 2025
Last updated in NPPESMay 18, 2026
Certification dateMay 18, 2026
Mailing address1790 Commerce Center Blvd, Fairborn, OH 45324-6358

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOPTOMETRY
Medical schoolOHIO STATE UNIVERSITY - COLLEGE OF OPTOMETRY
Graduated 2026 (0 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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