Provider Demographics
NPI:1295749091
Name:SWAGEL-WOOTTON EYE CENTER, INC
Entity type:Organization
Organization Name:SWAGEL-WOOTTON EYE CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-273-7449
Mailing Address - Street 1:PO BOX 200414
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-3941
Mailing Address - Country:US
Mailing Address - Phone:720-514-1001
Mailing Address - Fax:720-524-1121
Practice Address - Street 1:220 S 63RD ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1619
Practice Address - Country:US
Practice Address - Phone:480-641-3937
Practice Address - Fax:480-924-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17689332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1295749091OtherNPI
AZ1467424655OtherNPI DR JAMES A. HIATT M.D.
AZI04719OtherJAMES HIATT, M.D.
AZ1467424655OtherNPI
AZT36470Medicare UPIN
AZ1467424655OtherNPI
AZD00401Medicare UPIN
AZ1467424655OtherNPI DR JAMES A. HIATT M.D.
AZ0763550001Medicare NSC