Provider Demographics
NPI:1164539839
Name:TAMSETT-SCHMIDT, KENDRA JILL (OD)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:JILL
Last Name:TAMSETT-SCHMIDT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 BUSINESS CENTER DR STE 4
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4401
Mailing Address - Country:US
Mailing Address - Phone:904-278-1760
Mailing Address - Fax:904-278-1730
Practice Address - Street 1:1515 BUSINESS CENTER DR STE 4
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4401
Practice Address - Country:US
Practice Address - Phone:904-278-1760
Practice Address - Fax:904-278-1730
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410045595OtherRAILROAD MEDICARE
5673714OtherAETNA
410045595OtherRAILROAD MEDICARE
U74692Medicare UPIN