Provider Demographics
NPI:1275653602
Name:FOWLER, DARLENE (OD)
Entity Type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18250 N 32ND ST UNIT 1051
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:TARGET OPTICAL
Practice Address - Street 2:13731 W. BELL RD.
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3871
Practice Address - Country:US
Practice Address - Phone:623-975-4404
Practice Address - Fax:623-975-4487
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1488152W00000X
VA0618001385152W00000X
MDTA1827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist