Provider Demographics
NPI:1376587154
Name:SWANSON, CHRIS PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:PAUL
Last Name:SWANSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 NW CACHE RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3606
Mailing Address - Country:US
Mailing Address - Phone:580-248-0061
Mailing Address - Fax:580-248-0074
Practice Address - Street 1:4250 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3606
Practice Address - Country:US
Practice Address - Phone:580-248-0061
Practice Address - Fax:580-248-0074
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2288152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK24432801OtherMEDICARE PTAN
OK100766270AMedicaid
OKU75461Medicare UPIN
OK100766270AMedicaid