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General NPI Number Information
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NPI Number | 1063103745
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Entity Type | Individual
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Provider Name | CHERYL TORRANCE FOWLER LDOC, ABO, NCLEC
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Gender | Female
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 7305 BROAD ST
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3158
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Country | US
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Telephone | 352-796-6366
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Fax | 352-796-4213
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Provider Business Mailing Address
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Address Line | 26206 WILLOW ST
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City | BROOKSVILLE
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State | FL
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Zip | 34601-4731
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Country | US
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Telephone | 352-584-1542
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Fax | 352-796-4213
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 3058
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License Number State | FL
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