Provider Demographics
NPI:1194790246
Name:SWANSON, ROBERT EUGENE (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
Last Name:SWANSON
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 1:7450 FRANCE AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5189
Mailing Address - Country:US
Mailing Address - Phone:952-832-8100
Mailing Address - Fax:952-832-8188
Practice Address - Street 1:560 S MAPLE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1733
Practice Address - Country:US
Practice Address - Phone:952-442-4445
Practice Address - Fax:952-442-2455
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1478152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN980D1SWOtherBCBS
MN140002774OtherMEDICARE
MN233823800Medicaid
MN419000488Medicare ID - Type Unspecified
MN233823800Medicaid