Provider Demographics
NPI:1114210192
Name:DOW, ELIZABETH A (OD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:DOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4361
Mailing Address - Country:US
Mailing Address - Phone:904-757-1495
Mailing Address - Fax:904-757-1497
Practice Address - Street 1:5255 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4361
Practice Address - Country:US
Practice Address - Phone:904-757-1495
Practice Address - Fax:904-757-1497
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110111800Medicaid