Provider Demographics
NPI:1073612727
Name:SWEARINGEN AND BRYAN
Entity Type:Organization
Organization Name:SWEARINGEN AND BRYAN
Other - Org Name:SHREVEPORT OPHTHALMOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SWEARINGEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-524-2222
Mailing Address - Street 1:1666 E BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:STE 235
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5714
Mailing Address - Country:US
Mailing Address - Phone:318-524-2222
Mailing Address - Fax:318-524-0113
Practice Address - Street 1:1666 E BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:STE 235
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5714
Practice Address - Country:US
Practice Address - Phone:318-524-2222
Practice Address - Fax:318-524-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACD7197OtherRRMEDICARE
LA5B787Medicare UPIN
LA0724780001Medicare NSC