Provider Demographics
NPI:1154330637
Name:MCDOWELL, GAVIN TRENT (OD)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:TRENT
Last Name:MCDOWELL
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-0370
Mailing Address - Country:US
Mailing Address - Phone:870-523-3333
Mailing Address - Fax:
Practice Address - Street 1:1920 MALCOLM AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3628
Practice Address - Country:US
Practice Address - Phone:870-523-3333
Practice Address - Fax:855-838-5851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR234106722Medicaid