Individual
MARK EDWARD SWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD MED
Contact information
Practice address
1124 S STATE ST, MICHIGAN COLLEGE OF OPTOMETRY, BIG RAPIDS, MI 49307-2256
(231) 591-2222
(231) 591-3991
Mailing address
1124 S STATE ST, MICHIGAN COLLEGE OF OPTOMETRY, BIG RAPIDS, MI 49307-2256
(231) 591-2222
(231) 591-3991
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003186
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4401840
—
MI
01
—
900006367
PRIORITY HEALTH
MI
01
—
999998001
USP
MI
01
—
M5003186
BLUE CROSS
MI
Enumeration date
07/21/2006
Last updated
08/12/2021
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