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Individual

MARK EVERETT SCHMIDT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
460 RONA PKWY, BROOKVILLE, OH 45309-1118
(937) 833-4054
(937) 833-4055
Mailing address
460 RONA PKWY, BROOKVILLE, OH 45309-1118
(419) 628-8267

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4047/T108
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0766523
OH
Enumeration date
09/23/2005
Last updated
04/02/2020
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