Provider Demographics
NPI:1134135585
Name:FOWLER EYECARE PL
Entity Type:Organization
Organization Name:FOWLER EYECARE PL
Other - Org Name:EYES ETC OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-337-3937
Mailing Address - Street 1:13451 MCGREGOR BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5923
Mailing Address - Country:US
Mailing Address - Phone:239-337-3937
Mailing Address - Fax:239-433-3968
Practice Address - Street 1:13451 MCGREGOR BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5923
Practice Address - Country:US
Practice Address - Phone:239-337-3937
Practice Address - Fax:239-433-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3888152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE957Medicare UPIN
FLAE957Medicare PIN