Provider Demographics
NPI:1093926438
Name:JIM I SOWDERS OD PC
Entity Type:Organization
Organization Name:JIM I SOWDERS OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:I
Authorized Official - Last Name:SOWDERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-275-6155
Mailing Address - Street 1:1615 O ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-4116
Mailing Address - Country:US
Mailing Address - Phone:812-275-6155
Mailing Address - Fax:812-278-9405
Practice Address - Street 1:1615 O ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-4116
Practice Address - Country:US
Practice Address - Phone:812-275-6155
Practice Address - Fax:812-278-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002066A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000223127OtherANTHEM
IN100166710AMedicaid
IN4881170001Medicare NSC
INT34868Medicare UPIN
IN100166710AMedicaid