Provider Demographics
NPI:1891936787
Name:ROMAYNE T. SWANSON O.D.
Entity Type:Organization
Organization Name:ROMAYNE T. SWANSON O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMAYNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-239-1177
Mailing Address - Street 1:612A THIRTEENTH STREET
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-7208
Mailing Address - Country:US
Mailing Address - Phone:805-239-1177
Mailing Address - Fax:805-239-2678
Practice Address - Street 1:612A THIRTEENTH STREET
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-7208
Practice Address - Country:US
Practice Address - Phone:805-239-1177
Practice Address - Fax:805-239-2678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7404T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0457090001Medicare NSC