1063403095 NPI number — KEVIN D SCHMIDT OD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063403095 NPI number — KEVIN D SCHMIDT OD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SCHMIDT

Provider First Name:

KEVIN

Provider Middle Name:

D

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

OD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1063403095

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/29/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

817 STALCUP CT

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FRANKLIN

Provider Business Mailing Address State Name:

TN

Provider Business Mailing Address Postal Code:

37064-5046

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

615-791-7637

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

5323 MOUNT VIEW RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ANTIOCH

Provider Business Practice Location Address State Name:

TN

Provider Business Practice Location Address Postal Code:

37013-2308

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

615-731-8900

Provider Business Practice Location Address Fax Number:

615-731-8990

Provider Enumeration Date:

10/31/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  ODT1329 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 3598366 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 910688 . This is a "BLOCK" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 4092399 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 3451027 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 4062044 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 4064075 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 4062033 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 4082325 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 3451334 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 4062022 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: TN1329 . This is a "EYEMED" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 5256068 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 7038576 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".