Healthcare Provider Details

I. General information

NPI: 1275813172
Provider Name (Legal Business Name): DR. BRANDON L SWINK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 ROGERS AVE SUITE 54
FORT SMITH AR
72903-2047
US

IV. Provider business mailing address

5111 ROGERS AVE SUITE 54
FORT SMITH AR
72903-2047
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-1496
  • Fax: 479-452-1830
Mailing address:
  • Phone: 479-452-1496
  • Fax: 479-452-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2671
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: