=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063403095
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN D SCHMIDT OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2005
-----------------------------------------------------
Last Update Date | 06/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5323 MOUNT VIEW RD
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37013-2308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-731-8900
-----------------------------------------------------
Fax | 615-731-8990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 817 STALCUP CT
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37064-5046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-791-7637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | ODT1329
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------