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NPI Code Detail

MEDICARE: DR. TODD C SWANSON OD

MEDICARE: DR. TODD C SWANSON OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2907-035WI
2152W00000XOptometrist2907WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21042571OTHERWIPHYSICIANS PLUS
360180OTHERWIDEAN HEALTH INSURANCE

General Provider Information

NPI Number : 1063475879
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TODD C SWANSON OD
Provider Business Mailing Address
First Line : 2900 S WISCONSIN AVE
Second Line :
City : RICE LAKE
State : WI
Zip : 54868-8578
Country : US
Telephone Number : 608-341-9636
Fax Number :
Provider Business Practice Location Address
First Line : 2900 S WISCONSIN AVE
Second Line :
City : RICE LAKE
State : WI
Zip : 54868-8578
Country : US
Telephone Number : 608-341-9636
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 05/18/2015

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