Provider Demographics
NPI:1326075862
Name:DR RALPH A SWETLOW LTD
Entity Type:Organization
Organization Name:DR RALPH A SWETLOW LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-578-3600
Mailing Address - Street 1:5653 COLUMBIA PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAILEYS CROSSROADS
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2872
Mailing Address - Country:US
Mailing Address - Phone:703-578-3600
Mailing Address - Fax:703-369-7089
Practice Address - Street 1:5653 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:BAILEYS CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22041-2874
Practice Address - Country:US
Practice Address - Phone:703-578-3600
Practice Address - Fax:703-369-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000112152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA424039Medicare ID - Type UnspecifiedGROUP NUMBER FOR MEDICARE
VA0259230001Medicare NSC