Individual
ELISABETH SARAH SWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4335 HAZEL AVE, FAIR OAKS, CA 95628-6669
(916) 966-6080
(916) 966-6919
Mailing address
4335 HAZEL AVE, FAIR OAKS, CA 95628-6669
(916) 966-6080
(916) 966-6919
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9676T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SD0096760
MEDI-CAL
CA
Enumeration date
10/25/2005
Last updated
10/20/2010
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