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General NPI Number Information
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NPI Number | 1780888081
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Entity Type | Organization
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Legal Business Name | FOWLE EYECARE ASSOCIATES PLC
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 120 MARCELL DR NE SUITE A
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City | ROCKFORD
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State | MI
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Zip | 49341-1362
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Country | US
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Telephone | 616-866-0140
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Fax | 616-866-8694
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Provider Business Mailing Address
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Address Line | 120 MARCELL DR NE SUITE A
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City | ROCKFORD
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State | MI
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Zip | 49341-1362
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Country | US
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Telephone | 616-866-0140
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Fax | 616-866-8694
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Authorized Official
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Title or Position | OWNER
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Name | GARY J FOLWE
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Credential | OD
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Telephone | 616-866-0140
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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 | 4901002906
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License Number State | MI
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