Provider Demographics
NPI:1982600078
Name:SCHWARTZ, JASON LEWIS (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEWIS
Last Name:SCHWARTZ
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 1:1378 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1708
Mailing Address - Country:US
Mailing Address - Phone:954-467-6227
Mailing Address - Fax:954-779-7354
Practice Address - Street 1:1378 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1708
Practice Address - Country:US
Practice Address - Phone:954-467-6227
Practice Address - Fax:954-779-7354
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3170152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U97483Medicare UPIN
FL20007ZMedicare ID - Type Unspecified