Healthcare Provider Details

I. General information

NPI: 1306354220
Provider Name (Legal Business Name): SWIFT LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E ORVIS ST
MASSENA NY
13662-4232
US

IV. Provider business mailing address

351 E ORVIS ST
MASSENA NY
13662-4232
US

V. Phone/Fax

Practice location:
  • Phone: 315-276-3335
  • Fax:
Mailing address:
  • Phone: 315-276-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberC0073701
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. LORRAINE FREGOE
Title or Position: OPTICIAN
Credential: OPTICIAN
Phone: 315-276-3335