Provider Demographics
NPI:1235197617
Name:MCGOWAN, JAMIE D (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:D
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4820 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1601
Mailing Address - Country:US
Mailing Address - Phone:913-888-1888
Mailing Address - Fax:913-888-1975
Practice Address - Street 1:4820 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1601
Practice Address - Country:US
Practice Address - Phone:913-888-1888
Practice Address - Fax:913-888-1975
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V07937Medicare UPIN