Healthcare Provider Details

I. General information

NPI: 1932194024
Provider Name (Legal Business Name): JASON B STOWE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 3RD ST ESSENTIA HEALTH DULUTH CLINIC
DULUTH MN
55805-1951
US

IV. Provider business mailing address

400 E 3RD ST ESSENTIA HEALTH DULUTH CLINIC
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8364
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2787
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: