Provider Demographics
NPI:1033124607
Name:COWLES, NEILL S (OD)
Entity Type:Individual
Prefix:DR
First Name:NEILL
Middle Name:S
Last Name:COWLES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 CROWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-1969
Mailing Address - Country:US
Mailing Address - Phone:508-945-2552
Mailing Address - Fax:508-945-0533
Practice Address - Street 1:259 CROWELL RD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633-1969
Practice Address - Country:US
Practice Address - Phone:508-945-2552
Practice Address - Fax:508-945-0533
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2185152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
702411OtherTUFTS MEDICARE PREFERRED
151469OtherHARVARD PILGRIM HEALTH CA
540909092OtherRAILROAD MEDICARE
MA0303704Medicaid
2200461OtherUNITED HEALTHCARE
MAW15481OtherBLUE CROSS BLUE SHIELD
MAW15481OtherBLUE CROSS BLUE SHIELD
151469OtherHARVARD PILGRIM HEALTH CA
540909092OtherRAILROAD MEDICARE
0135710001Medicare NSC