MEDICARE: TOM SOWASH O.D. & ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1023650355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOM SOWASH O.D. & ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	175 E HOUSTON ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2255
Country	:	US
Telephone Number	:	800-340-0129
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	302 E BELL RD STE 150
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2434
Country	:	US
Telephone Number	:	602-560-2912
Fax Number	:	602-548-3024

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	DOLSIE MCDONALD
Credential	:
Telephone Number	:	726-444-4078

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	10/08/2019

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