MEDICARE: TOM SOWASH OD & ASSOCIATES P C

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

General Provider Information

NPI Number	:	1811134034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOM SOWASH OD & ASSOCIATES P C

Provider Business Mailing Address
First Line	:	11103 WEST AVE
Second Line	:	STE. 6
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1338
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	7000 E MAYO BLVD BLDG A
Second Line	:	STE. 1034
City	:	PHOENIX
State	:	AZ
Zip	:	85054-6151
Country	:	US
Telephone Number	:	480-513-3106
Fax Number	:	480-515-6246

Authorized Official
Title or Position	:	OWNER
Name	:	TOM SOWASH
Credential	:	OD
Telephone Number	:	720-570-0660

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/09/2009

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