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General NPI Number Information
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NPI Number | 1720146277
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Entity Type | Organization
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Legal Business Name | DR P O SWANSON OD PC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 333 CHURCH
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City | OTTUMWA
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State | IA
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Zip | 52501
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Country | US
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Telephone | 641-684-4695
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Fax | 641-684-7201
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Provider Business Mailing Address
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Address Line | 333 CHURCH
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City | OTTUMWA
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State | IA
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Zip | 52501
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Country | US
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Telephone | 641-684-4695
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Fax | 641-684-7201
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Authorized Official
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Title or Position | PRES
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Name | DR. ROBERT LEE BLEW
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Credential | OD
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Telephone | 641-684-4695
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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 | 1734
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License Number State | IA
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