Provider Demographics
NPI:1063475879
Name:SWANSON, TODD C (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:C
Last Name:SWANSON
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 1:2900 S WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8578
Mailing Address - Country:US
Mailing Address - Phone:608-341-9636
Mailing Address - Fax:
Practice Address - Street 1:2900 S WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8578
Practice Address - Country:US
Practice Address - Phone:608-341-9636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2907-035152W00000X
WI2907152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38620100Medicaid
WI1042571OtherPHYSICIANS PLUS
WI60180OtherDEAN HEALTH INSURANCE
WI60180OtherDEAN HEALTH INSURANCE
U92646Medicare UPIN
WI1042571OtherPHYSICIANS PLUS