Healthcare Provider Details

I. General information

NPI: 1952513707
Provider Name (Legal Business Name): KEVIN SCHWARZ OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 N AVALON ST
MEMPHIS TN
38112-5106
US

IV. Provider business mailing address

448 N AVALON ST
MEMPHIS TN
38112-5106
US

V. Phone/Fax

Practice location:
  • Phone: 901-276-8364
  • Fax:
Mailing address:
  • Phone: 901-276-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2417
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2417
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: