MEDICARE: DR. NICOLE SWISTAK O.D.

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	DCOP1000079	DC

General Provider Information

NPI Number	:	1720072630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE SWISTAK O.D.

Provider Business Mailing Address
First Line	:	3007 12TH ST S
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4315
Country	:	US
Telephone Number	:	703-271-7076
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 BROOKLEY AVE
Second Line	:
City	:	BOLLING AFB
State	:	DC
Zip	:	20332-0001
Country	:	US
Telephone Number	:	202-404-7753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/08/2007

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