Provider Demographics
NPI:1659496909
Name:SWANIC, MATTHEW JOHN (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:SWANIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9555 S EASTERN AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-8008
Mailing Address - Country:US
Mailing Address - Phone:702-816-2525
Mailing Address - Fax:702-586-3562
Practice Address - Street 1:9555 S EASTERN AVE STE 260
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-8008
Practice Address - Country:US
Practice Address - Phone:702-816-2525
Practice Address - Fax:702-586-3562
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV13823207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1659496909Medicaid
NVV106518OtherMEDICARE PTAN