Basic Information
| Provider Information | |||||||||
| NPI: | 1609228089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWANHOLM | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593445555 | ||||||||
| FaxNumber: | 8593445554 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 JAMES SIMPSON JR WAY | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410110801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596553111 | ||||||||
| FaxNumber: | 8596553110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2016 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT.006714 | OH | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 2057DT | KY | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.