MEDICARE: TOM SOWASH OD & ASSOCIATES

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1801983184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOM SOWASH OD & ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 849764
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-9764
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	9617 NORTH METRO PARKWAY WEST
Second Line	:	SUITE 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	:	O.D.
Telephone Number	:	720-570-4338

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	08/22/2008

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