Provider Demographics
NPI:1215969035
Name:SCHWARTZBERG, EDWARD J (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:SCHWARTZBERG
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 1:2955 CRAIN HIGHWAY
Mailing Address - Street 2:SUITE A&B
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601
Mailing Address - Country:US
Mailing Address - Phone:301-843-1000
Mailing Address - Fax:301-843-1919
Practice Address - Street 1:2955 CRAIN HIGHWAY
Practice Address - Street 2:SUITE A&B
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601
Practice Address - Country:US
Practice Address - Phone:301-843-1000
Practice Address - Fax:301-843-1919
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0624152W00000X
VA0618001126152W00000X
DCOP726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC000J98E22Medicare PIN
MDT59962Medicare UPIN
MD747L679DMedicare PIN