Provider Demographics
NPI:1518957299
Name:SWANGER, LARRY DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DAVID
Last Name:SWANGER
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 1:2020 GRAND AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-4293
Mailing Address - Country:US
Mailing Address - Phone:515-223-1266
Mailing Address - Fax:515-223-1020
Practice Address - Street 1:2020 GRAND AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-4293
Practice Address - Country:US
Practice Address - Phone:515-223-1266
Practice Address - Fax:515-223-1020
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00140015OtherUHC-RAILROAD MED.
IA0073544Medicaid
IA07354Medicare ID - Type Unspecified
IATOO477Medicare UPIN