Provider Demographics
NPI:1558331926
Name:SWATTS, MICHAEL S (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:SWATTS
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 1:1249 CEDAR RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7292
Mailing Address - Country:US
Mailing Address - Phone:757-436-3937
Mailing Address - Fax:757-436-3209
Practice Address - Street 1:1249 CEDAR RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7292
Practice Address - Country:US
Practice Address - Phone:757-436-3937
Practice Address - Fax:757-436-3209
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601800316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010014646Medicaid
VA001800V85Medicare ID - Type Unspecified
VA010014646Medicaid