Provider Demographics
NPI:1356453039
Name:NOWELL, TODD DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:DAVID
Last Name:NOWELL
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 1:2601 FOREST ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606
Mailing Address - Country:US
Mailing Address - Phone:352-688-1102
Mailing Address - Fax:352-688-1103
Practice Address - Street 1:2601 FOREST ROAD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606
Practice Address - Country:US
Practice Address - Phone:352-688-1102
Practice Address - Fax:352-688-1103
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20766OtherBCBS
FL20766OtherBLUE CROSS BLUE SHIELD
FL620262400Medicaid
FL20766OtherBLUE CROSS BLUE SHIELD
FLK1436Medicare ID - Type Unspecified
FLU68450Medicare UPIN
FL620262400Medicaid
1210800001Medicare NSC
FL20766OtherBCBS