MEDICARE: DR. GAVIN TRENT MCDOWELL O.D.

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	2577	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154330637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAVIN TRENT MCDOWELL O.D.

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	NEWPORT
State	:	AR
Zip	:	72112-0370
Country	:	US
Telephone Number	:	870-523-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 MALCOLM AVE
Second Line	:
City	:	NEWPORT
State	:	AR
Zip	:	72112-3628
Country	:	US
Telephone Number	:	870-523-3333
Fax Number	:	855-838-5851

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/23/2021

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