Provider Demographics
NPI:1992767842
Name:SCHWARTZ, SCOTT M (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
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 1:1086 FAIRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8913
Mailing Address - Country:US
Mailing Address - Phone:937-492-9197
Mailing Address - Fax:937-492-1901
Practice Address - Street 1:1086 FAIRINGTON DR
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8913
Practice Address - Country:US
Practice Address - Phone:937-492-9197
Practice Address - Fax:937-492-1901
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0176440001OtherDMERC
OH0176440005OtherDMERC
OH2454017Medicaid
OH0176440001OtherDMERC
OH0176440005OtherDMERC