Provider Demographics
NPI:1497753701
Name:ROUW, JOSEPH (OD, FAAO, FCOVD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:ROUW
Suffix:
Gender:M
Credentials:OD, FAAO, FCOVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 HABERSHAM CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8003
Mailing Address - Country:US
Mailing Address - Phone:678-448-2854
Mailing Address - Fax:
Practice Address - Street 1:2920 RONALD REAGAN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7578
Practice Address - Country:US
Practice Address - Phone:770-904-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1441152W00000X
TN2581152W00000X
GA2353152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMR1269984OtherDEA #
V06178Medicare UPIN
TNMR1269984OtherDEA #