Swetlishnoff, Dale J

Swetlishnoff, Dale J is an individual health care provider with primary practice located at 1025 S 6Th St , Springfield IL 62703-2403. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Swetlishnoff, Dale J can be contacted via phone (217) 528-7541.

Contact Information

Primary practice address
1025 S 6Th St Springfield IL 62703-2403
Phone: (217) 528-7541
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046008093 Illinois

Profile Details

NPI number 1649233057
LBN Legal business name Swetlishnoff, Dale J
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 7th, 2006
Last updated Aug 28th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649233057 NPPES
Illinois Other P00382237 RR MEDICARE
Illinois MEDICAID 046008093 RR MEDICARE

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