Provider Demographics
NPI:1508807165
Name:SCHMID, PETER M
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:SCHMID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 STATE ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-3969
Mailing Address - Country:US
Mailing Address - Phone:330-422-9999
Mailing Address - Fax:330-422-0316
Practice Address - Street 1:1155 STATE ROUTE 303
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-3969
Practice Address - Country:US
Practice Address - Phone:330-422-9999
Practice Address - Fax:330-422-0316
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0753797Medicaid
OH1325590001OtherADMINISTAR FEDERAL
OHU65749Medicare UPIN
OH0753797Medicaid