Provider Demographics
NPI:1508000522
Name:JOHN W SWINFORD O D
Entity Type:Organization
Organization Name:JOHN W SWINFORD O D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SWINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:520-293-2443
Mailing Address - Street 1:3430 N 1ST AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1803
Mailing Address - Country:US
Mailing Address - Phone:520-293-2443
Mailing Address - Fax:520-293-9442
Practice Address - Street 1:3430 N 1ST AVE STE 3
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1803
Practice Address - Country:US
Practice Address - Phone:520-293-2443
Practice Address - Fax:520-293-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0655220001Medicare NSC