Provider Demographics
NPI:1184937070
Name:SWADER, DEREK EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:EDWARD
Last Name:SWADER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720
Mailing Address - Country:US
Mailing Address - Phone:620-431-0010
Mailing Address - Fax:620-431-6959
Practice Address - Street 1:32 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1701
Practice Address - Country:US
Practice Address - Phone:620-431-0010
Practice Address - Fax:620-431-6959
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist