Healthcare Provider Details

I. General information

NPI: 1508807165
Provider Name (Legal Business Name): PETER M SCHMID
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 STATE ROUTE 303
STREETSBORO OH
44241-3969
US

IV. Provider business mailing address

1155 STATE ROUTE 303
STREETSBORO OH
44241-3969
US

V. Phone/Fax

Practice location:
  • Phone: 330-422-9999
  • Fax: 330-422-0316
Mailing address:
  • Phone: 330-422-9999
  • Fax: 330-422-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: