Provider Demographics
NPI:1285833087
Name:COWGILL, TERRY E (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:E
Last Name:COWGILL
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 1100
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0042
Mailing Address - Country:US
Mailing Address - Phone:425-890-8100
Mailing Address - Fax:
Practice Address - Street 1:200 NW BIRCH PL
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3204
Practice Address - Country:US
Practice Address - Phone:425-890-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0665990001OtherDMERC MEDICARE
WA2038701Medicaid
0665990001OtherDMERC MEDICARE