Provider Demographics
NPI:1912906397
Name:SCHMITZ, JOHN M (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:SCHMITZ
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 1:31000 TELEGRAPH RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4360
Mailing Address - Country:US
Mailing Address - Phone:248-433-3399
Mailing Address - Fax:
Practice Address - Street 1:31000 TELEGRAPH RD
Practice Address - Street 2:SUITE 140
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4360
Practice Address - Country:US
Practice Address - Phone:248-433-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS5002763152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4310718Medicaid
MI4310718Medicaid
MIT33470Medicare UPIN