Provider Demographics
NPI:1326164641
Name:MCSWAIN, TERRELL VANCE SR (LDO)
Entity Type:Individual
Prefix:MR
First Name:TERRELL
Middle Name:VANCE
Last Name:MCSWAIN
Suffix:SR
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:123 W HENDRY ST
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-3256
Mailing Address - Country:US
Mailing Address - Phone:912-876-7363
Mailing Address - Fax:912-368-7363
Practice Address - Street 1:123 W HENDRY ST
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3256
Practice Address - Country:US
Practice Address - Phone:912-876-7363
Practice Address - Fax:912-368-7363
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00507156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55397254SAMedicare PIN