Provider Demographics
NPI:1528039369
Name:DR. DENNIS E. COWLEY, P.C.
Entity Type:Organization
Organization Name:DR. DENNIS E. COWLEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:COWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-946-3971
Mailing Address - Street 1:633 E 13TH ST
Mailing Address - Street 2:P.O. BOX 365
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-1157
Mailing Address - Country:US
Mailing Address - Phone:574-946-3971
Mailing Address - Fax:574-946-6843
Practice Address - Street 1:633 E 13TH ST
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-1157
Practice Address - Country:US
Practice Address - Phone:574-946-3971
Practice Address - Fax:574-946-6843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN56000127A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
220000Medicare PIN
0194310001Medicare NSC