Provider Demographics
NPI:1043210487
Name:SCHMOLLY, DAVID L (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:SCHMOLLY
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 1:537 MOUNT JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16102-2619
Mailing Address - Country:US
Mailing Address - Phone:724-667-2020
Mailing Address - Fax:724-667-9201
Practice Address - Street 1:537 MOUNT JACKSON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16102-2619
Practice Address - Country:US
Practice Address - Phone:724-667-2020
Practice Address - Fax:724-667-9201
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07040026Medicaid
093567OtherHIGHMARK BC/BSHIELD
PA251234458OtherTRICARE NORTH REGION
PA313155OtherUPMC HEALTH PLAN
5140137OtherAETNA
50532OtherHEALTH AMERICA/HEALTH ASS
T28464Medicare UPIN
PA093567Medicare PIN
5140137OtherAETNA
PA0195760001Medicare NSC