Provider Demographics
NPI:1164509105
Name:SCHWARTZ, AMY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W TOMICHI AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2708
Mailing Address - Country:US
Mailing Address - Phone:970-641-2422
Mailing Address - Fax:970-641-9155
Practice Address - Street 1:302 W TOMICHI AVE STE A
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2708
Practice Address - Country:US
Practice Address - Phone:970-641-2422
Practice Address - Fax:970-641-9155
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09189874Medicaid
COC804962Medicare ID - Type Unspecified
CO09189874Medicaid