Provider Demographics
NPI:1649366113
Name:SCHWAN, CAROL A (OD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:SCHWAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:503 FURYS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-9059
Practice Address - Country:US
Practice Address - Phone:706-860-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001258152W00000X
SC1416152W00000X
MDTA2457152W00000X
GAOPT002077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA810603069OtherTRICARE
GA436700096AMedicaid
SCD62077Medicaid
GA41ZCFHFMedicare ID - Type Unspecified
GA436700096AMedicaid
SCD62077Medicaid