Provider Demographics
NPI:1063403095
Name:SCHMIDT, KEVIN D (OD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 STALCUP CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5046
Mailing Address - Country:US
Mailing Address - Phone:615-791-7637
Mailing Address - Fax:
Practice Address - Street 1:5323 MOUNT VIEW RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2308
Practice Address - Country:US
Practice Address - Phone:615-731-8900
Practice Address - Fax:615-731-8990
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1329152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3598366Medicaid
TN910688OtherBLOCK
TN4092399OtherBCBS
TN3451027OtherAETNA
TN4062044OtherBCBS
TN4064075OtherBCBS
TN4062033OtherBCBS
TN4082325OtherBCBS
TN3451334OtherAETNA
TN4062022OtherBCBS
TNTN1329OtherEYEMED
TN5256068OtherAETNA
TN7038576OtherAETNA
TN4064075OtherBCBS
TN4062022OtherBCBS
TN3598365Medicare ID - Type Unspecified
TN3598364Medicare ID - Type Unspecified
TN4062044OtherBCBS
TNTN1329OtherEYEMED
TNU03107Medicare UPIN