Provider Demographics
NPI:1225209604
Name:SCHWARTZ, JACKIE L (OD)
Entity Type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:L
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 1:2605 N HIATUS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1303
Mailing Address - Country:US
Mailing Address - Phone:954-433-4770
Mailing Address - Fax:954-443-4266
Practice Address - Street 1:2605 N HIATUS RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-1303
Practice Address - Country:US
Practice Address - Phone:954-433-4770
Practice Address - Fax:954-443-4266
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist