Provider Demographics
NPI:1124146634
Name:LORETTA K. SCHMIDGALL, O.D., PC
Entity type:Organization
Organization Name:LORETTA K. SCHMIDGALL, O.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHMIDGALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-292-3668
Mailing Address - Street 1:3211 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-4515
Mailing Address - Country:US
Mailing Address - Phone:717-292-3668
Mailing Address - Fax:717-292-1034
Practice Address - Street 1:3211 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-4515
Practice Address - Country:US
Practice Address - Phone:717-292-3668
Practice Address - Fax:717-292-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00148941OtherMEDICARE RR
SC113345OtherHIGHMARK BLUE SHIELD
95045OtherVISION BENEFITS OF AMER
A13345OtherAMERIHEALTH ADMIN
0104701000OtherAMERIHEALTH 65
01528701OtherCAPITAL BLUE CROSS
PA01898579Medicaid
2421907OtherAETNA
00148941OtherMEDICARE ID TYPE UNSPECIFIED
01528701OtherNCAS PENNSYLVANIA
02523900OtherCAPITAL BLUE CROSS
18107OtherHEALTH AMER HEALTH ASSUR
01528701OtherKEYSTONE HEALTHPLAN
5748087OtherFIRST HEALTH NETWORK
P00148941OtherMEDICARE ID
01528701OtherCAPITAL BLUE CROSS
PA01898579Medicaid
18107OtherHEALTH AMER HEALTH ASSUR
P00148941OtherMEDICARE ID
01528701OtherKEYSTONE HEALTHPLAN
PA0625430001Medicare NSC