Provider Demographics
NPI:1790346104
Name:SCHWAB, LARIESA (OD)
Entity Type:Individual
Prefix:DR
First Name:LARIESA
Middle Name:
Last Name:SCHWAB
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 1:10300 LITTLE PATUXENT PKWY STE 1625
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-7003
Mailing Address - Country:US
Mailing Address - Phone:410-730-0007
Mailing Address - Fax:
Practice Address - Street 1:10300 LITTLE PATUXENT PKWY STE 1625
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-7003
Practice Address - Country:US
Practice Address - Phone:410-730-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDA2690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist