Individual
TARA SWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
1815 STATE ST, WATERTOWN, NY 13601-9407
(315) 786-8064
(315) 788-1950
Mailing address
1815 STATE ST, WATERTOWN, NY 13601-9407
(315) 786-8064
(315) 788-1950
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
009466
NY
Other
Enumeration date
03/04/2016
Last updated
03/04/2016
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