Provider Demographics
NPI:1982820502
Name:SCHWARTZ, LONN GARY (OD)
Entity type:Individual
Prefix:
First Name:LONN
Middle Name:GARY
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 1:3751 SHELDON DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3139
Mailing Address - Country:US
Mailing Address - Phone:805-302-9665
Mailing Address - Fax:
Practice Address - Street 1:5434 CARPINTERIA AVE
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-1423
Practice Address - Country:US
Practice Address - Phone:805-684-5476
Practice Address - Fax:805-684-5477
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU08267Medicare UPIN