Provider Demographics
NPI:1366448870
Name:SOWA, MICHAEL JUDE (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUDE
Last Name:SOWA
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 1:2145 HENDERSONVILLE RD
Mailing Address - Street 2:STE D
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-9724
Mailing Address - Country:US
Mailing Address - Phone:828-681-8000
Mailing Address - Fax:828-681-0990
Practice Address - Street 1:2145 HENDERSONVILLE RD
Practice Address - Street 2:STE D
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-9724
Practice Address - Country:US
Practice Address - Phone:828-681-8000
Practice Address - Fax:828-681-0990
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1243152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2271716OtherUNITED HEALTHCARE
NC0929GOtherBCBS
NC890929GMedicaid
NCP00159332OtherRAILROAD MEDICARE
NCP00159332OtherRAILROAD MEDICARE
NC246623NMedicare ID - Type Unspecified