MEDICARE: TOM SOWASH OD & ASSOCIATES PC

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1578778635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOM SOWASH OD & ASSOCIATES PC

Provider Business Mailing Address
First Line	:	PO BOX 849764
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-9764
Country	:	US
Telephone Number	:	210-524-6803
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	7000 E MAYO BLVD BLDG A
Second Line	:	SUITE 1034
City	:	PHOENIX
State	:	AZ
Zip	:	85054-6151
Country	:	US
Telephone Number	:	480-513-3106
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS M SOWASH
Credential	:	OD
Telephone Number	:	210-524-6803

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	09/02/2008

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