Provider Demographics
NPI:1649650409
Name:SWAN, KATHRYN (OD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SWAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:KULOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 HANG DOG LN
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4101
Mailing Address - Country:US
Mailing Address - Phone:860-331-6647
Mailing Address - Fax:
Practice Address - Street 1:38 TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1200
Practice Address - Country:US
Practice Address - Phone:860-785-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist