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General NPI Number Information
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NPI Number | 1568719136
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Entity Type | Organization
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Legal Business Name | JOSEPH GOWEN, O.D. AND ASSOCIATES, LLC
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 4420 N. FREEWAY RD.
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City | PUEBLO
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State | CO
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Zip | 81008
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Country | US
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Telephone | 719-296-6597
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Fax |
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Provider Business Mailing Address
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Address Line | 4420 N. FREEWAY RD.
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City | PUEBLO
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State | CO
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Zip | 81008
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Country | US
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Telephone | 719-296-6597
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH GOWEN
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Credential | O.D.
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Telephone | 719-502-5385
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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 | 2486
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License Number State | CO
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