Provider Demographics
NPI:1518022169
Name:LADONNA SWAN INC
Entity type:Organization
Organization Name:LADONNA SWAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:REINHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:716-649-4545
Mailing Address - Street 1:5895 SOUTHPARK AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3738
Mailing Address - Country:US
Mailing Address - Phone:716-649-4545
Mailing Address - Fax:716-649-4545
Practice Address - Street 1:5895 SOUTHPARK AVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3738
Practice Address - Country:US
Practice Address - Phone:716-649-4545
Practice Address - Fax:716-649-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
8217706156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000589688001OtherBCBS OF WNY
OCUT01153006OtherVETERANS ADMINISTRATION
00011190001OtherUNIVERA HEALTHCARE
0890048OtherINDEPENDENT HEALTH
00011190001OtherUNIVERA HEALTHCARE
0190070001Medicare ID - Type UnspecifiedREGION A B C D