Healthcare Provider Details

I. General information

NPI: 1245286996
Provider Name (Legal Business Name): GINA A DYDA SCHMID OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11736 W BROAD ST STE 106B
HENRICO VA
23233-1189
US

IV. Provider business mailing address

11736 W BROAD ST STE 106B
HENRICO VA
23233-1189
US

V. Phone/Fax

Practice location:
  • Phone: 804-360-1590
  • Fax: 804-535-4572
Mailing address:
  • Phone: 804-360-1590
  • Fax: 814-536-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001740
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: