Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 18003106B | IN |
NPI | 1003934118 |
---|---|
Provider Name | Dr. Brian Charles Swift |
First Address | Indianapolis, IN 46214-3637 |
Second Address | Lebanon, IN 46052-1100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 26/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U80812 | (02) |