Healthcare Provider Details

I. General information

NPI: 1477569077
Provider Name (Legal Business Name): KURT M SCHMITT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 R C HOAG DR LIONEL R JOHN HEALTH CENTER
SALAMANCA NY
14779-1365
US

IV. Provider business mailing address

987 R C HOAG DR LIONEL R JOHN HEALTH CENTER
SALAMANCA NY
14779-1365
US

V. Phone/Fax

Practice location:
  • Phone: 716-945-5894
  • Fax: 716-945-5889
Mailing address:
  • Phone: 716-945-5894
  • Fax: 716-945-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006303
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: