Provider Demographics
NPI:1205993078
Name:DRS SWANSON SOWERS LEE & YAGER PA
Entity type:Organization
Organization Name:DRS SWANSON SOWERS LEE & YAGER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:J
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-841-6220
Mailing Address - Street 1:214 E MARKS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3819
Mailing Address - Country:US
Mailing Address - Phone:407-841-6220
Mailing Address - Fax:407-423-2285
Practice Address - Street 1:214 E MARKS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3819
Practice Address - Country:US
Practice Address - Phone:407-841-6220
Practice Address - Fax:407-423-2285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS SWANSON SOWERS LEE & YAGER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-02
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL1134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0455110001Medicare NSC
FLCJ8206Medicare PIN
FL33785Medicare PIN