Provider Demographics
NPI:1376973305
Name:DEREK E SWADER OD PA
Entity Type:Organization
Organization Name:DEREK E SWADER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:SWADER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-431-0010
Mailing Address - Street 1:32 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-1701
Mailing Address - Country:US
Mailing Address - Phone:620-431-0010
Mailing Address - Fax:
Practice Address - Street 1:32 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1701
Practice Address - Country:US
Practice Address - Phone:620-431-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty