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General NPI Number Information
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NPI Number | 1134135585
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Entity Type | Organization
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Legal Business Name | FOWLER EYECARE PL
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 13451 MCGREGOR BLVD STE 3
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City | FORT MYERS
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State | FL
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Zip | 33919-5923
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Country | US
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Telephone | 239-337-3937
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Fax | 239-433-3968
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Provider Business Mailing Address
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Address Line | 13451 MCGREGOR BLVD STE 3
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City | FORT MYERS
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State | FL
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Zip | 33919-5923
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Country | US
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Telephone | 239-337-3937
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Fax | 239-433-3968
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEANNINE M FOWLER
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Credential | OD
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Telephone | 239-337-3937
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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 | OPC3888
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License Number State | FL
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