Healthcare Provider Details

I. General information

NPI: 1366468571
Provider Name (Legal Business Name): SOWASH OPTOMETRY GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9078 WESTVIEW RD
LONE TREE CO
80124-5155
US

IV. Provider business mailing address

175 E HOUSTON ST
SAN ANTONIO TX
78205-2255
US

V. Phone/Fax

Practice location:
  • Phone: 303-662-8977
  • Fax: 303-662-1565
Mailing address:
  • Phone: 210-524-6771
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TOM SOWASH
Title or Position: OWNER
Credential: OD
Phone: 720-962-6906