Provider Demographics
NPI:1790949824
Name:R J ROWE OD PC
Entity Type:Organization
Organization Name:R J ROWE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:229-890-8016
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-0288
Mailing Address - Country:US
Mailing Address - Phone:229-263-8851
Mailing Address - Fax:229-263-7417
Practice Address - Street 1:104 N MADISON ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-2012
Practice Address - Country:US
Practice Address - Phone:229-263-8851
Practice Address - Fax:229-263-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00274293AMedicaid
GA00274293AMedicaid