Provider Demographics
NPI:1710143938
Name:DR. AMY GOWER LLC
Entity Type:Organization
Organization Name:DR. AMY GOWER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:GOWER
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-240-2698
Mailing Address - Street 1:2240 W DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-2069
Mailing Address - Country:US
Mailing Address - Phone:803-425-9657
Mailing Address - Fax:
Practice Address - Street 1:2240 W DEKALB ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2069
Practice Address - Country:US
Practice Address - Phone:803-425-9657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty