Provider Demographics
NPI:1548200108
Name:SCHMID, SAMUEL H (OD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:H
Last Name:SCHMID
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 1:1408 W BRITTON RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1316
Mailing Address - Country:US
Mailing Address - Phone:405-848-3619
Mailing Address - Fax:405-848-3646
Practice Address - Street 1:1408 W BRITTON RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1316
Practice Address - Country:US
Practice Address - Phone:405-848-3619
Practice Address - Fax:405-848-3646
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1548200108OtherBLUE CROSS BLUE SHIELD
OK100765000AMedicaid
OK0705410001Medicare NSC
OK1548200108OtherBLUE CROSS BLUE SHIELD
OK1790944411Medicare PIN
OKT40638Medicare UPIN