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General NPI Number Information
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NPI Number | 1588959613
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Entity Type | Organization
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Legal Business Name | CARL A SWANSON OD
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 2509 7TH AVE S SUITE C3
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City | GREAT FALLS
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State | MT
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Zip | 59405-3030
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Country | US
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Telephone | 406-761-2211
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Fax | 406-761-2261
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Provider Business Mailing Address
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Address Line | 2509 7TH AVE S SUITE C3
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City | GREAT FALLS
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State | MT
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Zip | 59405-3030
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Country | US
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Telephone | 406-761-2211
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Fax | 406-761-2261
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CARL A SWANSON
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Credential | OD
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Telephone | 406-761-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | T89265
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License Number State | MT
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