Provider Demographics
NPI:1508170341
Name:SWITALSKI, BOGUSLAW
Entity Type:Individual
Prefix:
First Name:BOGUSLAW
Middle Name:
Last Name:SWITALSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6469 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-1657
Mailing Address - Country:US
Mailing Address - Phone:954-993-6543
Mailing Address - Fax:
Practice Address - Street 1:2401 S STEMMONS FWY
Practice Address - Street 2:SUITE 2210
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8775
Practice Address - Country:US
Practice Address - Phone:972-459-4908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7644T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist