Provider Demographics
NPI:1962488924
Name:SCHMITZ, SARA ELLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELLEN
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:ELLEN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2533 WOODSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5436
Mailing Address - Country:US
Mailing Address - Phone:314-423-3874
Mailing Address - Fax:314-423-2872
Practice Address - Street 1:2533 WOODSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-5436
Practice Address - Country:US
Practice Address - Phone:314-423-3874
Practice Address - Fax:314-423-2872
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005019940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11488946OtherCAQH
MO2005019940OtherMISSOURI LICENSE
MOV06993Medicare UPIN