Provider Demographics
NPI:1003934118
Name:SWIFT, BRIAN CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHARLES
Last Name:SWIFT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 MARYVALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3637
Mailing Address - Country:US
Mailing Address - Phone:317-797-1754
Mailing Address - Fax:
Practice Address - Street 1:2440 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1100
Practice Address - Country:US
Practice Address - Phone:765-482-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003106B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80812Medicare UPIN