Healthcare Provider Details

I. General information

NPI: 1720077845
Provider Name (Legal Business Name): KORINNE MARIE SWAIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 WHITEHALL RD STE. B
MUSKEGON MI
49445-2497
US

IV. Provider business mailing address

3359 MEMORIAL DR
MUSKEGON MI
49445-2129
US

V. Phone/Fax

Practice location:
  • Phone: 231-744-3573
  • Fax:
Mailing address:
  • Phone: 231-744-1394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: