MEDICARE: DR. GARY J FOWLE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901002906	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1780888081	OTHER	GROUP NPI
2	1427020023	OTHER	INDIVIDUAL NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427020023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY J FOWLE OD

Provider Business Mailing Address
First Line	:	120 MARCELL DR NE
Second Line	:	SUITE A
City	:	ROCKFORD
State	:	MI
Zip	:	49341-1362
Country	:	US
Telephone Number	:	616-866-0140
Fax Number	:	616-866-8694

Provider Business Practice Location Address
First Line	:	120 MARCELL DR NE
Second Line	:	SUITE A
City	:	ROCKFORD
State	:	MI
Zip	:	49341-1362
Country	:	US
Telephone Number	:	616-866-0140
Fax Number	:	616-866-8694

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	06/30/2026

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