Provider Demographics
NPI:1730272279
Name:SCHWERS, JEFFREY E (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:SCHWERS
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 1:440 E STATE ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4966
Mailing Address - Country:US
Mailing Address - Phone:208-939-7000
Mailing Address - Fax:
Practice Address - Street 1:440 E STATE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4966
Practice Address - Country:US
Practice Address - Phone:208-939-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000287600Medicaid
ID000287600Medicaid
ID1592733Medicare PIN