Provider Demographics
NPI:1770846990
Name:SCHAWAROCH, IRINA (OD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:SCHAWAROCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:
Other - Last Name:BENERAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:812 WHEELER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2949
Mailing Address - Country:US
Mailing Address - Phone:631-750-7051
Mailing Address - Fax:631-246-0935
Practice Address - Street 1:812 WHEELER RD STE 106
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2949
Practice Address - Country:US
Practice Address - Phone:631-750-7051
Practice Address - Fax:631-246-0935
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007840-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400080046Medicare PIN