Provider Demographics
NPI:1649221698
Name:MCDOWALL, JOHN D (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:MCDOWALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:D
Other - Last Name:MCDOWALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:766 ST HELENS AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3706
Mailing Address - Country:US
Mailing Address - Phone:253-627-8711
Mailing Address - Fax:253-627-1104
Practice Address - Street 1:766 ST HELENS AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3706
Practice Address - Country:US
Practice Address - Phone:253-627-8711
Practice Address - Fax:253-627-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029841Medicaid
WA2029841Medicaid
WA5762550001Medicare NSC
WAG8853489Medicare PIN