Provider Demographics
NPI:1275813172
Name:SWINK, BRANDON L
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:L
Last Name:SWINK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 ROGERS AVE
Mailing Address - Street 2:SUITE 54
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2047
Mailing Address - Country:US
Mailing Address - Phone:479-452-1496
Mailing Address - Fax:479-452-1830
Practice Address - Street 1:5111 ROGERS AVE
Practice Address - Street 2:SUITE 54
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2047
Practice Address - Country:US
Practice Address - Phone:479-452-1496
Practice Address - Fax:479-452-1830
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist