Provider Demographics
NPI:1063746055
Name:SWIGART, NICOLE LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LYNN
Last Name:SWIGART
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 E GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-2037
Mailing Address - Country:US
Mailing Address - Phone:262-740-7213
Mailing Address - Fax:262-740-7226
Practice Address - Street 1:1819 E GENEVA ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-2037
Practice Address - Country:US
Practice Address - Phone:262-740-7213
Practice Address - Fax:262-740-7226
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4491152W00000X
IL046-010529152W00000X
WI3321-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC4491OtherFLORIDA LICENSE
WI3321-35OtherOPTOMETRY LICENSE
IL046-010529OtherOPTOMETRY LICENSE
IL046-010529OtherOPTOMETRY LICENSE