Provider Demographics
NPI:1578555108
Name:SCHMIDT, AMANDA RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:RENEE
Last Name: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 1:7355 N PALM AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5770
Mailing Address - Country:US
Mailing Address - Phone:559-225-2020
Mailing Address - Fax:559-227-6411
Practice Address - Street 1:7355 N PALM AVE STE 109
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5770
Practice Address - Country:US
Practice Address - Phone:559-225-2020
Practice Address - Fax:559-227-6411
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10526T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U73659Medicare UPIN
CAZZZ26965ZMedicare PIN