Provider Demographics
NPI:1073728945
Name:SCHMIDT, CARL H (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:H
Last Name:SCHMIDT
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 1:1619 E SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5213
Mailing Address - Country:US
Mailing Address - Phone:317-783-9497
Mailing Address - Fax:
Practice Address - Street 1:1619 E SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5213
Practice Address - Country:US
Practice Address - Phone:317-783-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001383A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5518860001Medicare NSC
T81915Medicare UPIN
IN260320Medicare PIN