Provider Demographics
NPI: | 1225283781 |
---|---|
Name: | SOWASH OPTOMETRY GROUP P.C. |
Entity Type: | Organization |
Organization Name: | SOWASH OPTOMETRY GROUP P.C. |
Other - Org Name: | VISIONWORKS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | THOMAS |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | SOWASH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 720-570-0660 |
Mailing Address - Street 1: | PO BOX 848209 |
Mailing Address - Street 2: | |
Mailing Address - City: | DALLAS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75284-8209 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-524-6803 |
Mailing Address - Fax: | 210-524-6587 |
Practice Address - Street 1: | 6252 S CENTRAL ST |
Practice Address - Street 2: | |
Practice Address - City: | AURORA |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80016-5325 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-693-0333 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-11-25 |
Last Update Date: | 2012-12-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332H00000X | Suppliers | Eyewear Supplier |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 40058778 | Medicaid | |
CO | 5754490016 | Medicare NSC |