Individual
DR. MIRA B SWIECICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
201 S 19TH ST, LYNDEN, WA 98264-1725
(360) 354-2222
(360) 354-0737
Mailing address
201 S 19TH ST, LYNDEN, WA 98264-1725
(360) 354-2222
(360) 354-0737
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3271TX
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0108450
LABOR & INDUSTRIES
WA
05
—
2019891
—
WA
01
—
6524SW
REGENCE BLUE SHIELD
WA
01
—
G8851040
MEDICARE ID-PIN
WA
01
—
P00190648
RAILROAD MEDICARE-PALMETT
WA
Enumeration date
04/19/2006
Last updated
01/09/2013
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