Provider Demographics
NPI:1598824724
Name:SCHWARTZ, PAUL T (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:T
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 1:2575 OTISCO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:13110-3247
Mailing Address - Country:US
Mailing Address - Phone:315-636-8376
Mailing Address - Fax:
Practice Address - Street 1:106 DRYDEN RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4628
Practice Address - Country:US
Practice Address - Phone:607-273-1234
Practice Address - Fax:315-273-8526
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB7650Medicare ID - Type Unspecified