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General NPI Number Information
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NPI Number | 1598954638
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Entity Type | Individual
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Provider Name | JUSTIN MARK ROWE O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 339 DEINHARD LN
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City | MCCALL
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State | ID
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Zip | 83638-4703
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Country | US
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Telephone | 208-634-2020
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Fax | 208-634-1716
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Provider Business Mailing Address
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Address Line | 204 LENORA ST
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City | MCCALL
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State | ID
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Zip | 83638-3844
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Country | US
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Telephone | 208-634-4161
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Fax | 208-634-1716
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001924
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-100139
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License Number State | ID
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