Provider Demographics
NPI:1457311607
Name:FOWLER, LITTLETON AUGUSTUS SR (OD)
Entity Type:Individual
Prefix:DR
First Name:LITTLETON
Middle Name:AUGUSTUS
Last Name:FOWLER
Suffix:SR
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 1:4224 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3013
Mailing Address - Country:US
Mailing Address - Phone:903-794-3711
Mailing Address - Fax:903-794-3713
Practice Address - Street 1:4224 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3013
Practice Address - Country:US
Practice Address - Phone:903-794-3711
Practice Address - Fax:903-794-3713
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1849TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1457311607OtherNPI
TX82037OtherAR BCBS
TX82037OtherTX BCBS
TX8K2795Medicare PIN