Provider Demographics
NPI:1396841813
Name:SWARINGEN, SANDRA LOVE (OD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LOVE
Last Name:SWARINGEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3515
Mailing Address - Country:US
Mailing Address - Phone:336-667-3288
Mailing Address - Fax:336-838-1092
Practice Address - Street 1:48 BOONE TRL
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3515
Practice Address - Country:US
Practice Address - Phone:336-667-3288
Practice Address - Fax:336-838-1092
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09882OtherBLUE CROSS BLUE SHIELD
NC8909882Medicaid
NCY1388OtherSERVICES FOR THE BLIND
246379Medicare ID - Type Unspecified
NC8909882Medicaid