Provider Demographics
NPI:1568745354
Name:COWART, ASHLEY L (OD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:COWART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1613
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:11512 LAKE MEAD AVE
Practice Address - Street 2:STE 534
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9680
Practice Address - Country:US
Practice Address - Phone:904-564-2020
Practice Address - Fax:904-518-3297
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4610152W00000X
GAOPT002899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01806374OtherRAILROAD MEDICARE
FL190HJOtherBCBS-FL
FLFU684XOtherMEDICARE
FLFU684YMedicare PIN