Provider Demographics
NPI:1407876634
Name:SCHMIDT, TERRY D (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:D
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 1:107 6TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-2609
Mailing Address - Country:US
Mailing Address - Phone:701-663-0313
Mailing Address - Fax:701-663-1604
Practice Address - Street 1:107 6TH AVE NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-2609
Practice Address - Country:US
Practice Address - Phone:701-663-0313
Practice Address - Fax:701-663-1604
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60315Medicaid
ND60315Medicaid