Individual
ALICIA SWANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
431 W COLISEUM BLVD, FORT WAYNE, IN 46805-1010
(260) 484-8516
Mailing address
431 W COLISEUM BLVD, FORT WAYNE, IN 46805-1010
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003847A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201238170
—
IN
Enumeration date
06/23/2014
Last updated
08/11/2014
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