Provider Demographics
NPI:1730603465
Name:SCHMIDT, TAYLOR JEAN (OD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JEAN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:JEAN
Other - Last Name:CHESNUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:555 N NEW BALLAS RD STE 232
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6849
Mailing Address - Country:US
Mailing Address - Phone:314-375-2020
Mailing Address - Fax:314-492-8684
Practice Address - Street 1:555 N NEW BALLAS RD STE 232
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6849
Practice Address - Country:US
Practice Address - Phone:314-375-2020
Practice Address - Fax:314-492-8684
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018020283152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist