MEDICARE: DR. ANDREW FOWLE 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	4901004839	MI

General Provider Information

NPI Number	:	1215343124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW FOWLE O.D.

Provider Business Mailing Address
First Line	:	120 MARCELL DR NE
Second Line	:	SUITE A
City	:	ROCKFORD
State	:	MI
Zip	:	49341-1362
Country	:	US
Telephone Number	:	616-866-0140
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 MARCELL DR NE
Second Line	:	SUITE A
City	:	ROCKFORD
State	:	MI
Zip	:	49341-1362
Country	:	US
Telephone Number	:	616-866-0140
Fax Number	:

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

Provider Enumeration Date	:	07/11/2014
Last Update Date	:	06/30/2026

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