Provider Demographics
NPI:1669438263
Name:SWANSON, CRAIG ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ROBERT
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 1:10174 OTTER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8873
Mailing Address - Country:US
Mailing Address - Phone:248-722-9598
Mailing Address - Fax:
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383655994OtherMEBS
383655994OtherBCI ADMINISTRATORS
MI383655994OtherSET INCORPORATED
383655994OtherCIGNA
MI383655994OtherMUTUAL EYE CLAIMS AUDIT
MI383655994OtherHERITAGE OPICAL
383655994OtherCAMBRIDGE
383655994OtherCBCA
MI383655994OtherPPOM
462242001OtherADMINISTAR
MI383655994OtherSUPERIOR VISION SERVICES
383655994OtherHEALTH APPLICANTS NETWORK
C5003253OtherBCBS
383655994OtherHARRINGTON BENEFIT SVCS
383655994OtherAETNA
MI383655994OtherMAIL HANDLERS
MI383655994OtherPRINCIPAL FINANCIAL GROUP
383655994OtherDELTA VISION
462242001OtherADMINISTAR
ON60600Medicare ID - Type Unspecified