Healthcare Provider Details

I. General information

NPI: 1225550635
Provider Name (Legal Business Name): JENNIFER FOWLER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 FAR HILLS AVE
OAKWOOD OH
45419-1634
US

IV. Provider business mailing address

2601 FAR HILLS AVE
OAKWOOD OH
45419-1634
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-1703
  • Fax: 937-298-6344
Mailing address:
  • Phone: 937-298-1703
  • Fax: 937-298-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.006675
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: