Provider Demographics
NPI:1346467891
Name:SCHMIDT, RUSSELL STANFORD (OD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:STANFORD
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 1:5661 N ANGUS ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6112
Mailing Address - Country:US
Mailing Address - Phone:559-439-9727
Mailing Address - Fax:559-229-4763
Practice Address - Street 1:4710 N CEDAR AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-1086
Practice Address - Country:US
Practice Address - Phone:559-225-0150
Practice Address - Fax:559-299-4763
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5596152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
005596Medicare ID - Type Unspecified