Provider Demographics
NPI:1699045294
Name:SCHMIDT, DAVID STEVENSON JR
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:STEVENSON
Last Name:SCHMIDT
Suffix:JR
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 1:875 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8150
Mailing Address - Country:US
Mailing Address - Phone:716-832-0296
Mailing Address - Fax:716-832-0943
Practice Address - Street 1:875 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8150
Practice Address - Country:US
Practice Address - Phone:716-832-0296
Practice Address - Fax:716-832-0943
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4982156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician