Provider Demographics
NPI:1629630439
Name:POWERS, LOGAN THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:THOMAS
Last Name:POWERS
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 1:9424 N 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2714
Mailing Address - Country:US
Mailing Address - Phone:602-633-6900
Mailing Address - Fax:
Practice Address - Street 1:9424 N 25TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2714
Practice Address - Country:US
Practice Address - Phone:602-633-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002875152W00000X
OHOPT.006804152W00000X
AZOPT-002634152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist