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General NPI Number Information
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NPI Number | 1003934118
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Entity Type | Individual
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Provider Name | BRIAN CHARLES SWIFT O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 2440 N LEBANON ST
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City | LEBANON
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State | IN
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Zip | 46052-1100
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Country | US
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Telephone | 765-482-3766
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Fax |
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Provider Business Mailing Address
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Address Line | 6955 MARYVALE CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46214-3637
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Country | US
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Telephone | 317-797-1754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003106B
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License Number State | IN
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