Derek E Swader OD PA
Organization Active NPI Optometrist · Chanute, KS
NPI 1376973305 · NPPES record last updated Nov 12, 2013
Key facts
- NPI
- 1376973305
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 1880 (KS)
- Legal business name
- DEREK E SWADER OD PA
- Practice address
- 32 W Main St
Chanute, KS 66720-1701 - Phone
- (620) 431-0010
- NPI assigned
- Nov 12, 2013
- Organization subpart
- No
Authorized official
- Name
- Dr. Derek Swader, O.D.
- Title
- Optometrist
- Phone
- (620) 431-0010
Practitioners 2
-
Rebecca Clover, OD
-
Derek Edward Swader, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140227001711 | KS | Part B Supplier - Clinic/Group Practice | 4880824416 |
Receives reassigned benefits from 2 practitioners Practice locations: Chanute, KS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 1880 | KS | Yes |
Addresses
Primary practice location
32 W Main St
Chanute, KS 66720-1701
Mailing address
32 W Main St
Chanute, KS 66720-1701
Phone (620) 431-0010
Other providers in Chanute, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.