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NPI Code Detail

MEDICARE: SOWASH OPTOMETRY GROUP PC

MEDICARE: SOWASH OPTOMETRY GROUP 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
1332H00000XEyewear Supplier

Other Identifiers

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

General Provider Information

NPI Number : 1396761540
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOWASH OPTOMETRY GROUP PC
Provider Business Mailing Address
First Line : 175 E HOUSTON ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78205-2255
Country : US
Telephone Number : 210-524-6771
Fax Number : 210-524-6587
Provider Business Practice Location Address
First Line : 2407 S COLLEGE AVE
Second Line : UNIT 300
City : FORT COLLINS
State : CO
Zip : 80525-1773
Country : US
Telephone Number : 970-484-3787
Fax Number : 970-484-0133
Authorized Official
Title or Position : OWNER
Name : TOM SOWASH
Credential : OD
Telephone Number : 720-962-6906
Provider Enumeration Date : 07/14/2006
Last Update Date : 12/17/2015

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