Provider Demographics
NPI:1336151836
Name:SWANSON, CHAD M (OD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:M
Last Name:SWANSON
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 1:3116 SADDLE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8637
Mailing Address - Country:US
Mailing Address - Phone:406-443-4040
Mailing Address - Fax:406-443-0773
Practice Address - Street 1:3116 SADDLE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8637
Practice Address - Country:US
Practice Address - Phone:406-443-4040
Practice Address - Fax:406-443-0773
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT772152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0483837Medicaid
MT000025163Medicare ID - Type Unspecified
MT0483837Medicaid