Provider Demographics
NPI:1447248646
Name:SWALES, RICHARD S (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:SWALES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6315
Mailing Address - Country:US
Mailing Address - Phone:580-357-6911
Mailing Address - Fax:580-357-6919
Practice Address - Street 1:2518 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6315
Practice Address - Country:US
Practice Address - Phone:580-357-6911
Practice Address - Fax:580-357-6919
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763140AMedicaid
OK100763140AMedicaid