Provider Demographics
NPI:1013990241
Name:SWARTZ, SHERRY LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LEE
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SHERRY
Other - Middle Name:LEE
Other - Last Name:KNOTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-1442
Mailing Address - Country:US
Mailing Address - Phone:304-265-1851
Mailing Address - Fax:304-265-0028
Practice Address - Street 1:216 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1442
Practice Address - Country:US
Practice Address - Phone:304-265-1851
Practice Address - Fax:304-265-0028
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV998-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3102041000Medicaid
WV9329581Medicare PIN
WV4739330001Medicare NSC
WVU88109Medicare UPIN