Provider Demographics
NPI:1720077845
Name:SWAIN, KORINNE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KORINNE
Middle Name:MARIE
Last Name:SWAIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3359 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2129
Mailing Address - Country:US
Mailing Address - Phone:231-744-1394
Mailing Address - Fax:
Practice Address - Street 1:1179 WHITEHALL RD
Practice Address - Street 2:STE. B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-2497
Practice Address - Country:US
Practice Address - Phone:231-744-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003090152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900F165250OtherBLUE CROSS & BLUE SHIELD
MI1806648Medicaid
MI1806648Medicaid