Provider Demographics
NPI:1538244371
Name:SCHMIDT, CHRISTINE L (OD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 S BROADWAY STE G
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7886
Mailing Address - Country:US
Mailing Address - Phone:805-928-8878
Mailing Address - Fax:805-928-3358
Practice Address - Street 1:2011 S BROADWAY STE G
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7886
Practice Address - Country:US
Practice Address - Phone:805-928-8878
Practice Address - Fax:805-928-3358
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8850T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0088500Medicaid
CA1262470001Medicare NSC
CASD0088500Medicaid
OP8850Medicare ID - Type Unspecified