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General NPI Number Information
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NPI Number | 1093926438
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Entity Type | Organization
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Legal Business Name | JIM I SOWDERS OD PC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 1615 O ST
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City | BEDFORD
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State | IN
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Zip | 47421-4116
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Country | US
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Telephone | 812-275-6155
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Fax | 812-278-9405
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Provider Business Mailing Address
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Address Line | 1615 O ST
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City | BEDFORD
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State | IN
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Zip | 47421-4116
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Country | US
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Telephone | 812-275-6155
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Fax | 812-278-9405
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JIM I SOWDERS
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Credential | OD
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Telephone | 812-275-6155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002066A
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License Number State | IN
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