Provider Demographics
NPI:1093713828
Name:SWANSON, RHONDA (OD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 MOSSOP DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-4105
Mailing Address - Country:US
Mailing Address - Phone:206-617-2845
Mailing Address - Fax:
Practice Address - Street 1:4420 MERIDIAN ST
Practice Address - Street 2:KULSHAN EYE CARE
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8087
Practice Address - Country:US
Practice Address - Phone:360-647-0212
Practice Address - Fax:360-647-2212
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0156SWOtherASURIS(REGENCE NW HEALTH)
WAA032OtherTRICARE
WA2029221Medicaid
WA0185489OtherLABOR AND INDUSTRIES
WA28261OtherGROUP HEALTH
WAWA0690OtherNORTHWEST BENEFIT NETWORK
WA28261OtherGROUP HEALTH