Provider Demographics
NPI:1710951462
Name:SCHWARTZ, ROBERTA C (OD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:C
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 1:6915 174TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3410
Mailing Address - Country:US
Mailing Address - Phone:718-969-4717
Mailing Address - Fax:
Practice Address - Street 1:69-15 174 ST
Practice Address - Street 2:FLUSHING
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-3410
Practice Address - Country:US
Practice Address - Phone:718-969-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV00433-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5342892OtherCIGNA
NY796543Medicaid
NY3971910OtherAETNA HMO
NYP3629977OtherOXFORD
NY6599194OtherGHI
NY7820088OtherAETNA PPO/EPO/POS
NYP3629977OtherOXFORD
NY05410MMedicare ID - Type Unspecified