Basic Information
| Provider Information | |||||||||
| NPI: | 1619022514 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHMIDT | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8312 WOODCREST DR NE | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493418507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168743046 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2735 28TH ST SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495121610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169742020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901003588 | MI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.