Provider Demographics
NPI:1154770725
Name:SWAIN, MARTIKA SHONTA (OD,)
Entity type:Individual
Prefix:MRS
First Name:MARTIKA
Middle Name:SHONTA
Last Name:SWAIN
Suffix:
Gender:F
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:PO BOX 207243
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7243
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:5850 US HIGHWAY 431 # A
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-2048
Practice Address - Country:US
Practice Address - Phone:256-878-0125
Practice Address - Fax:256-878-0939
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-D58-TA-A54152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL219541Medicaid
AL219023Medicaid