Provider Demographics
NPI:1649342239
Name:SWOFFORD, DAVID LAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAYNE
Last Name:SWOFFORD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4420 NELSON BROGDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3477
Mailing Address - Country:US
Mailing Address - Phone:770-932-9656
Mailing Address - Fax:770-932-6606
Practice Address - Street 1:4420 NELSON BROGDON BLVD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3477
Practice Address - Country:US
Practice Address - Phone:770-932-9656
Practice Address - Fax:770-932-6606
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00431637AMedicaid
GA41ZCBXNMedicare PIN