Provider Demographics
NPI:1578656278
Name:NORTHWEST OPTOMETRY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:NORTHWEST OPTOMETRY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-225-2020
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10526T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9703435Medicaid
CA0710660001Medicare NSC
CASD0105261Medicare PIN
CAU73659Medicare UPIN