Provider Demographics
NPI:1003982851
Name:SCHMITT, WARREN S (OD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:S
Last Name:SCHMITT
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:PO BOX 2082
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32727-2082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1851 KNOX MCRAE DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5492
Practice Address - Country:US
Practice Address - Phone:321-268-2266
Practice Address - Fax:321-385-3926
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4322801OtherAETNA PROVIDER NUMBER
FL078849000Medicaid
FL20143OtherBCBS OF FL PROVIDER #
FL20143Medicare ID - Type UnspecifiedPROVIDER NUMBER
FL078849000Medicaid