Provider Demographics
NPI:1588959613
Name:CARL A SWANSON OD
Entity type:Organization
Organization Name:CARL A SWANSON OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-761-2211
Mailing Address - Street 1:2509 7TH AVE S
Mailing Address - Street 2:SUITE C3
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3030
Mailing Address - Country:US
Mailing Address - Phone:406-761-2211
Mailing Address - Fax:406-761-2261
Practice Address - Street 1:2509 7TH AVE S
Practice Address - Street 2:SUITE C3
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3030
Practice Address - Country:US
Practice Address - Phone:406-761-2211
Practice Address - Fax:406-761-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTT89265332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier