Provider Demographics
NPI:1821059932
Name:COWAN, STEPHEN (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:COWAN
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 1:2700 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3009
Mailing Address - Country:US
Mailing Address - Phone:806-355-9536
Mailing Address - Fax:806-353-5572
Practice Address - Street 1:2700 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3009
Practice Address - Country:US
Practice Address - Phone:806-355-9536
Practice Address - Fax:806-353-5572
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2228TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12797Medicare UPIN
TX4406730001Medicare NSC
TX00152SMedicare PIN
TX4504500001Medicare NSC
TX80130EMedicare PIN
TXCJ6720Medicare PIN
TX8K5915Medicare PIN
TX410046421Medicare PIN