MEDICARE: JAMES W. SWEDBERG, LLC

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
1	152W00000X	Optometrist	458	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1063586477	OTHER	NV	INDIVIDUAL NPI FOR JAMES SWEDBERG, O.D.

General Provider Information

NPI Number	:	1710177415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES W. SWEDBERG, LLC

Provider Business Mailing Address
First Line	:	9044 WOLF DANCER AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-5411
Country	:	US
Telephone Number	:	702-353-8534
Fax Number	:	702-222-3956

Provider Business Practice Location Address
First Line	:	1807 W CRAIG RD
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-0217
Country	:	US
Telephone Number	:	702-399-1141
Fax Number	:	702-222-3956

Authorized Official
Title or Position	:	MEMBER/MANAGER LLC
Name	:	DR. JAMES W. SWEDBERG
Credential	:	O.D.
Telephone Number	:	702-353-8534

Provider Enumeration Date	:	07/28/2007
Last Update Date	:	08/27/2020

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