Provider Demographics
NPI:1700943115
Name:SWEZEY, JUDITH KAYE (OD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:KAYE
Last Name:SWEZEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:LAKE CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:56055-0158
Mailing Address - Country:US
Mailing Address - Phone:507-726-6639
Mailing Address - Fax:507-726-6382
Practice Address - Street 1:102 W HUMPHREY ST
Practice Address - Street 2:
Practice Address - City:LAKE CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:56055
Practice Address - Country:US
Practice Address - Phone:507-726-6639
Practice Address - Fax:507-726-6382
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN248078600Medicaid
MN280025000Medicaid
MN248078600Medicaid
MN0176630001Medicare NSC
MN280025000Medicaid