Provider Demographics
NPI:1013070648
Name:SWARTZ, BRENT PAUL (OD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:PAUL
Last Name:SWARTZ
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 1:2150 EWING CRAWFIS CIR
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9042
Mailing Address - Country:US
Mailing Address - Phone:937-593-1766
Mailing Address - Fax:937-593-1557
Practice Address - Street 1:2150 EWING CRAWFIS CIR
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9042
Practice Address - Country:US
Practice Address - Phone:937-593-1766
Practice Address - Fax:937-593-1557
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4596152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5251050001OtherDMERC
OH0194856Medicaid
OHSW9346631Medicare ID - Type UnspecifiedMEDICARE GROUP #
OH0194856Medicaid
OHSW0785562Medicare ID - Type UnspecifiedMEDICARE PROVIDER #