Provider Demographics
NPI:1043276371
Name:SCHWARTZ, BRADLEY E (OD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:E
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 1:805 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2318
Mailing Address - Country:US
Mailing Address - Phone:563-382-4279
Mailing Address - Fax:563-382-2672
Practice Address - Street 1:805 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2318
Practice Address - Country:US
Practice Address - Phone:563-382-4279
Practice Address - Fax:563-382-2672
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1934152W00000X
MN2332152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0065417Medicaid
IA0065417Medicaid
IA00158Medicare PIN