Provider Demographics
NPI:1710177415
Name:JAMES W. SWEDBERG, LLC
Entity Type:Organization
Organization Name:JAMES W. SWEDBERG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SWEDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-353-8534
Mailing Address - Street 1:9044 WOLF DANCER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-5411
Mailing Address - Country:US
Mailing Address - Phone:702-353-8534
Mailing Address - Fax:702-222-3956
Practice Address - Street 1:1807 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0217
Practice Address - Country:US
Practice Address - Phone:702-399-1141
Practice Address - Fax:702-222-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-28
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1710177415Medicaid
NV1063586477OtherINDIVIDUAL NPI FOR JAMES SWEDBERG, O.D.