Provider Demographics
NPI:1255500765
Name:MARK E. SCHMIDT OD
Entity type:Organization
Organization Name:MARK E. SCHMIDT OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-833-4054
Mailing Address - Street 1:460 RONA PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-1118
Mailing Address - Country:US
Mailing Address - Phone:937-833-4054
Mailing Address - Fax:937-833-4055
Practice Address - Street 1:460 RONA PKWY
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-1118
Practice Address - Country:US
Practice Address - Phone:937-833-4054
Practice Address - Fax:937-833-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4047332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0225100001Medicare NSC