Active NPI
Craig Robert Swanson, OD
- Optometrist
- Detroit, MI
National Provider Identifier
1669438263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901003253
- Practice address
- 4646 John R St
Detroit, MI 48201-1916 - Phone
- (313) 576-1000
- NPI assigned
- Apr 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003253 | MI | Primary |
Addresses
Primary practice location
4646 John R St
Detroit, MI 48201-1916
Mailing address
10174 Otter Dr
South Lyon, MI 48178-8873
Phone (248) 722-9598
Other identifiers 18
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 383655994 | Other | MI | MEBS |
| 383655994 | Other | BCI ADMINISTRATORS | |
| 383655994 | Other | MI | SET INCORPORATED |
| 383655994 | Other | CIGNA | |
| 383655994 | Other | MI | MUTUAL EYE CLAIMS AUDIT |
| 383655994 | Other | MI | HERITAGE OPICAL |
| 383655994 | Other | CAMBRIDGE | |
| 383655994 | Other | CBCA | |
| 383655994 | Other | MI | PPOM |
| 462242001 | Other | ADMINISTAR | |
| 383655994 | Other | MI | SUPERIOR VISION SERVICES |
| 383655994 | Other | HEALTH APPLICANTS NETWORK | |
| C5003253 | Other | BCBS | |
| 383655994 | Other | HARRINGTON BENEFIT SVCS | |
| 383655994 | Other | AETNA | |
| 383655994 | Other | MI | MAIL HANDLERS |
| 383655994 | Other | MI | PRINCIPAL FINANCIAL GROUP |
| 383655994 | Other | DELTA VISION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901003253 | MI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733097600000",
"number": "1669438263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10174 OTTER DR",
"city": "SOUTH LYON",
"state": "MI",
"postal_code": "481788873",
"telephone_number": "248-722-9598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4646 JOHN R ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482011916",
"telephone_number": "313-576-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SWANSON",
"first_name": "CRAIG",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-22",
"last_updated": "2024-12-02",
"certification_date": "2024-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901003253",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEBS",
"identifier": "383655994",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCI ADMINISTRATORS",
"identifier": "383655994",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SET INCORPORATED",
"identifier": "383655994",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "383655994",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MUTUAL EYE CLAIMS AUDIT",
"identifier": "383655994",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HERITAGE OPICAL",
"identifier": "383655994",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAMBRIDGE",
"identifier": "383655994",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CBCA",
"identifier": "383655994",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PPOM",
"identifier": "383655994",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADMINISTAR",
"identifier": "462242001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUPERIOR VISION SERVICES",
"identifier": "383655994",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH APPLICANTS NETWORK",
"identifier": "383655994",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "C5003253",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARRINGTON BENEFIT SVCS",
"identifier": "383655994",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "383655994",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAIL HANDLERS",
"identifier": "383655994",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRINCIPAL FINANCIAL GROUP",
"identifier": "383655994",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA VISION",
"identifier": "383655994",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.