=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164558631
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK JOSEPH DOWLING O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 04/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9993 LEWIS AND CLARK BLVD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63136-5322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-867-9945
-----------------------------------------------------
Fax | 314-867-7800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9993 LEWIS AND CLARK BLVD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63136-5322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-867-9945
-----------------------------------------------------
Fax | 314-867-7800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2569
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------