Provider Demographics
NPI:1306995162
Name:SCHWARTZ, LOUIS ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ALLEN
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 1:116 SW ELIZABETH CT
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-3107
Mailing Address - Country:US
Mailing Address - Phone:386-755-3279
Mailing Address - Fax:
Practice Address - Street 1:2201 N YOUNG BLVD
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1957
Practice Address - Country:US
Practice Address - Phone:352-493-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20188Medicare ID - Type Unspecified