Provider Demographics
NPI:1891869921
Name:SOWARDS, JESSE EDDIE (OD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:EDDIE
Last Name:SOWARDS
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 1:963 IVYDALE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-0928
Mailing Address - Country:US
Mailing Address - Phone:505-202-3844
Mailing Address - Fax:505-524-2961
Practice Address - Street 1:571 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-8449
Practice Address - Country:US
Practice Address - Phone:505-647-2020
Practice Address - Fax:505-524-2961
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist