Provider Demographics
NPI:1528710126
Name:EMILY S SCHWARTZ
Entity type:Organization
Organization Name:EMILY S SCHWARTZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:DOLD
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:612-205-6238
Mailing Address - Street 1:10205 101ST ST NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8856
Mailing Address - Country:US
Mailing Address - Phone:612-205-6238
Mailing Address - Fax:763-497-3319
Practice Address - Street 1:901 W SAINT GERMAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3460
Practice Address - Country:US
Practice Address - Phone:320-252-5404
Practice Address - Fax:320-252-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3013OtherSTATE LICENSE NUMBER