Provider Demographics
NPI:1881021756
Name:JUSTIN ROWE, O.D., P.A.
Entity Type:Organization
Organization Name:JUSTIN ROWE, O.D., P.A.
Other - Org Name:P. V. HAKES, O.D., P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-634-4161
Mailing Address - Street 1:204 LENORA ST
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-3844
Mailing Address - Country:US
Mailing Address - Phone:208-634-4161
Mailing Address - Fax:
Practice Address - Street 1:204 LENORA ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-3844
Practice Address - Country:US
Practice Address - Phone:208-634-4161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty