Provider Demographics
NPI:1992952386
Name:GEORGE L SCHMIDT OD PA
Entity type:Organization
Organization Name:GEORGE L SCHMIDT OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-622-8200
Mailing Address - Street 1:9123 N MILITARY TRL
Mailing Address - Street 2:STE 101
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5968
Mailing Address - Country:US
Mailing Address - Phone:561-622-8200
Mailing Address - Fax:561-622-8308
Practice Address - Street 1:9123 N MILITARY TRL
Practice Address - Street 2:STE 101
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5968
Practice Address - Country:US
Practice Address - Phone:561-622-8200
Practice Address - Fax:561-622-8308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1306332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19356Medicare PIN
T84102Medicare UPIN
FL0908060001Medicare NSC