Provider Demographics
NPI:1235130188
Name:ROWE, RICHARD DUWAYNE (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DUWAYNE
Last Name:ROWE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:D
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2711 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75428-3825
Mailing Address - Country:US
Mailing Address - Phone:903-886-3886
Mailing Address - Fax:
Practice Address - Street 1:2711 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-3825
Practice Address - Country:US
Practice Address - Phone:903-886-3886
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2345TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMR0613554OtherDEA NUMBER
TX00558PMedicare ID - Type UnspecifiedTHERAPEUTIC OPTOMETRIST
TXMR0613554OtherDEA NUMBER