Provider Demographics
NPI:1538641535
Name:SWISLOW, REBECCA (LDO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SWISLOW
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20627 59TH DR NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8287
Mailing Address - Country:US
Mailing Address - Phone:425-346-5764
Mailing Address - Fax:
Practice Address - Street 1:20627 59TH DR NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8287
Practice Address - Country:US
Practice Address - Phone:425-346-5764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO60240660156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician