Provider Demographics
NPI:1912022864
Name:SCHMIDT, MARYROSE LYNDI (OD)
Entity Type:Individual
Prefix:DR
First Name:MARYROSE
Middle Name:LYNDI
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LYNDI
Other - Middle Name:FANDINO
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:3610 SACRAMENTO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1734
Mailing Address - Country:US
Mailing Address - Phone:415-673-2020
Mailing Address - Fax:
Practice Address - Street 1:3610 SACRAMENTO ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1734
Practice Address - Country:US
Practice Address - Phone:415-673-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11796T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0117960Medicare UPIN