Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4596 | OH |
NPI | 1013070648 |
---|---|
Provider Name | Brent Paul Swartz |
First Address | Bellefontaine, OH 43311-9042 |
Second Address | Bellefontaine, OH 43311-9042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 25/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0194856 | (05) | OH |
5251050001 | DMERC (01) | OH |
U56436 | (02) | OH |