MEDICARE: TOM SOWASH OD & ASSOCIATES PC

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	:	1316184542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOM SOWASH OD & ASSOCIATES PC

Provider Business Mailing Address
First Line	:	11103 WEST AVE
Second Line	:	STE. 6
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1338
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	9617 NORTH PARKWAY WEST
Second Line	:	#1160
City	:	PHOENIX
State	:	AZ
Zip	:	85051
Country	:	US
Telephone Number	:	602-861-1670
Fax Number	:	602-861-1698

Authorized Official
Title or Position	:	OWNER
Name	:	TOM SOWASH
Credential	:	OD
Telephone Number	:	720-570-0660

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/09/2009

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