Provider Demographics
NPI:1629171616
Name:SCHMIDT, GALEN NEAL (OD)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:NEAL
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:P.O. BOX 54
Mailing Address - Street 2:
Mailing Address - City:GRAND COULEE
Mailing Address - State:WA
Mailing Address - Zip Code:99133
Mailing Address - Country:US
Mailing Address - Phone:509-663-0340
Mailing Address - Fax:509-633-0161
Practice Address - Street 1:407 BURDIN BLVD.
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133
Practice Address - Country:US
Practice Address - Phone:509-633-0340
Practice Address - Fax:509-633-0161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WATO2338Medicare UPIN