Healthcare Provider Details

I. General information

NPI: 1043240831
Provider Name (Legal Business Name): STEPHANIE SCHMIEDECKE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 DATAPOINT DR
SAN ANTONIO TX
78229-2384
US

IV. Provider business mailing address

1111 BLUFF FRST
SAN ANTONIO TX
78248-2611
US

V. Phone/Fax

Practice location:
  • Phone: 210-283-6800
  • Fax: 210-283-6825
Mailing address:
  • Phone: 832-541-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPC3741
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number6254TG
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6254TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: