Provider Demographics
NPI:1215248158
Name:SCHWARTZ, GEDALIA NATAN (OD)
Entity type:Individual
Prefix:DR
First Name:GEDALIA
Middle Name:NATAN
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3282 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5261
Mailing Address - Country:US
Mailing Address - Phone:757-484-8080
Mailing Address - Fax:757-483-6310
Practice Address - Street 1:3282 WESTERN BRANCH BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5261
Practice Address - Country:US
Practice Address - Phone:757-484-8080
Practice Address - Fax:757-483-6310
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00851562Medicare PIN
VAVAA101763Medicare PIN