Provider Demographics
NPI:1760571970
Name:SWIFT, THOMAS M (OPTOMETRIST)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:SWIFT
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 VAN NESS AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3285
Mailing Address - Country:US
Mailing Address - Phone:415-921-7555
Mailing Address - Fax:415-921-1475
Practice Address - Street 1:711 VAN NESS AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3285
Practice Address - Country:US
Practice Address - Phone:415-921-7555
Practice Address - Fax:415-921-1475
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7633TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0076330Medicare PIN