Healthcare Provider Details

I. General information

NPI: 1568459295
Provider Name (Legal Business Name): DENNIS A SWARNER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S WILLOW ST UNIT #108
KENAI AK
99611-7744
US

IV. Provider business mailing address

110 S WILLOW ST UNIT #108
KENAI AK
99611-7744
US

V. Phone/Fax

Practice location:
  • Phone: 907-283-7575
  • Fax: 907-283-6156
Mailing address:
  • Phone: 907-283-7575
  • Fax: 907-283-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number072
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: