Provider Demographics
NPI:1740255215
Name:MCGOWAN, JOSEPH J (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:MCGOWAN
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 1:2110 SLAUGHTER LN W
Mailing Address - Street 2:SUITE 129
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5992
Mailing Address - Country:US
Mailing Address - Phone:512-280-0520
Mailing Address - Fax:512-280-1656
Practice Address - Street 1:2110 SLAUGHTER LN W
Practice Address - Street 2:SUITE 129
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5992
Practice Address - Country:US
Practice Address - Phone:512-280-0520
Practice Address - Fax:512-280-1656
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05582TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00178PMedicare ID - Type UnspecifiedMEDICARE ID
TXU73594Medicare UPIN