Provider Demographics
NPI:1043222953
Name:SCHWARTZ, JACK ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:ROBERT
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 1:1341 HIGHWAY 9 STE 10
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4087
Mailing Address - Country:US
Mailing Address - Phone:732-240-9111
Mailing Address - Fax:732-286-1405
Practice Address - Street 1:1341 HIGHWAY 9 STE 10
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4087
Practice Address - Country:US
Practice Address - Phone:732-240-9111
Practice Address - Fax:732-286-1405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00350500152W00000X
NJ27TO00036100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ19534OtherAMERIGROUP OF NJ
NJ1605305Medicaid
NJ2K8849OtherHEALTHNET OF NORTHEAST
NJ0128907OtherAETNA HMO
NJP913886OtherOXFORD
NJ112337OtherEYEMED
NJ112337OtherEYEMED
NJ19534OtherAMERIGROUP OF NJ
NJP913886OtherOXFORD