Healthcare Provider Details

I. General information

NPI: 1164417374
Provider Name (Legal Business Name): CHERRI T. COWAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N. 5TH ST.
LEESVILLE LA
71446-3464
US

IV. Provider business mailing address

PO BOX 681
LEESVILLE LA
71496-0681
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-2020
  • Fax: 337-239-0755
Mailing address:
  • Phone: 337-239-2020
  • Fax: 337-239-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number954-129T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: