Provider Demographics
NPI:1720015811
Name:CLOWER, DAN L (OD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:L
Last Name:CLOWER
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 1:1601 EASTMAN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6471
Mailing Address - Country:US
Mailing Address - Phone:805-656-2020
Mailing Address - Fax:805-650-0543
Practice Address - Street 1:1601 EASTMAN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6471
Practice Address - Country:US
Practice Address - Phone:805-656-2020
Practice Address - Fax:805-650-0543
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5645TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0056450Medicaid
CAOP5645Medicare PIN
CAT70051Medicare UPIN
CASD0056450Medicaid