Healthcare Provider Details

I. General information

NPI: 1891404174
Provider Name (Legal Business Name): SOWASH OPTOMETRY GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S COLORADO BLVD STE 101
DENVER CO
80222-3336
US

IV. Provider business mailing address

175 E HOUSTON ST
SAN ANTONIO TX
78205-2299
US

V. Phone/Fax

Practice location:
  • Phone: 720-358-1093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DOLSIE MCDONALD
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 726-444-4078