Provider Demographics
NPI:1972564615
Name:SCHMIDGALL, LORETTA K (OD PC)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:K
Last Name:SCHMIDGALL
Suffix:
Gender:F
Credentials:OD PC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01528701OtherCAPITAL BLUE CROSS PROV
PA01528701OtherNCAS PA
02523900OtherCAPITAL BLUE CROSS GROUP
30540OtherGROUP VISION ASSOC
A13345OtherAMERIHEALTH ADMINISTRATOR
P00148941OtherMEDICARE ID
SC113345OtherHIGHMARK BLUE SHIELD
00148941OtherMEDICARE ID TYPE UNSPECIFIED
01528701OtherKEYSTONE HP
18107OtherHEALTH AMERICA ASSURANCE
2923668OtherVISION SERVICE PLAN
95045OtherVISION BENEFITS OF AMERIC
PAP00148941OtherMEDICARE RAILROAD
2421907OtherAETNA
3302OtherDAVIS VISION
PA01898579Medicaid
3302OtherDAVIS VISION
PA01528701OtherNCAS PA
95045OtherVISION BENEFITS OF AMERIC
PA01898579Medicaid