Provider Demographics
NPI:1710022512
Name:SWANSON EYECARE, PC
Entity Type:Organization
Organization Name:SWANSON EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-427-9620
Mailing Address - Street 1:39885 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2151
Mailing Address - Country:US
Mailing Address - Phone:248-427-9620
Mailing Address - Fax:248-427-9610
Practice Address - Street 1:39885 GRAND RIVER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2151
Practice Address - Country:US
Practice Address - Phone:248-427-9620
Practice Address - Fax:248-427-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION60600OtherHEALTH ALLIANCE PLAN(HAP)
ON60600OtherADMINISTAR
=========OtherBCI ADMINISTRATORS
=========OtherVISION SERVICE PLAN
ON60600OtherADMINISTAR
=========OtherUNITED HEALTHCARE
=========OtherDELTAVISION
MION60600OtherHEALTH ALLIANCE PLAN(HAP)
=========OtherCOMPBENEFITS
=========OtherHARRINGTON BENEFITS
=========OtherHAN
=========OtherMEBS
=========OtherWEYCO
=========OtherBCBS
=========OtherCIGNA
=========OtherTRICARE
=========OtherCAMBRIDGE
=========OtherWEYCO