Provider Demographics
NPI:1164560439
Name:SWARTZ, HOLLY DOW (OD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:DOW
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:DOW
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1103 S CEDAR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-2081
Mailing Address - Country:US
Mailing Address - Phone:517-676-9350
Mailing Address - Fax:517-676-8040
Practice Address - Street 1:1103 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-2081
Practice Address - Country:US
Practice Address - Phone:517-676-9350
Practice Address - Fax:517-676-8040
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003998152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900C361880OtherBLUE CROSS BLUE SHIELD
MIC36188003Medicare PIN