Provider Demographics
NPI:1538228226
Name:SWEARINGEN AND BURTON LLC
Entity type:Organization
Organization Name:SWEARINGEN AND BURTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:SWEARINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-682-3301
Mailing Address - Street 1:808 GULF ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-1239
Mailing Address - Country:US
Mailing Address - Phone:417-682-3301
Mailing Address - Fax:417-682-2409
Practice Address - Street 1:808 GULF ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-1239
Practice Address - Country:US
Practice Address - Phone:417-682-3301
Practice Address - Fax:417-682-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107638OtherBC/BS
MO536038102Medicaid
MODA0028OtherRR
MODA0028OtherRR
MO536038102Medicaid