Provider Demographics
NPI:1861780785
Name:SCHMIDT, KIMBERLY ANN (OD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:MABRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:333 S STATE ST STE T
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3948
Mailing Address - Country:US
Mailing Address - Phone:503-636-2762
Mailing Address - Fax:
Practice Address - Street 1:333 S STATE ST STE T
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3948
Practice Address - Country:US
Practice Address - Phone:503-636-2762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3401AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist