Provider Demographics
NPI:1790857472
Name:SCHWARTZ, EMILY SUZANNE DOLD (OD)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:SUZANNE DOLD
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:DOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:10205 101ST STREET NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55362
Mailing Address - Country:US
Mailing Address - Phone:612-205-6238
Mailing Address - Fax:763-497-3119
Practice Address - Street 1:901W SAINT GERMAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3460
Practice Address - Country:US
Practice Address - Phone:320-252-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLD3013000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410003706Medicare UPIN