Provider Demographics
NPI:1083630230
Name:SOWASH OPTOMETRY GROUP PC
Entity Type:Organization
Organization Name:SOWASH OPTOMETRY GROUP PC
Other - Org Name:VISIONWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWASH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:720-962-6906
Mailing Address - Street 1:175 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2255
Mailing Address - Country:US
Mailing Address - Phone:210-524-6771
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:14500 W COLFAX AVE
Practice Address - Street 2:524
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3203
Practice Address - Country:US
Practice Address - Phone:303-271-0354
Practice Address - Fax:303-271-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5754490014Medicare NSC