Provider Demographics
NPI:1831408913
Name:FOWLER, BEN C (OD)
Entity type:Individual
Prefix:MR
First Name:BEN
Middle Name:C
Last Name:FOWLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1450 SUGARLAND DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5730
Mailing Address - Country:US
Mailing Address - Phone:307-673-5177
Mailing Address - Fax:307-673-5170
Practice Address - Street 1:1450 SUGARLAND DR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5730
Practice Address - Country:US
Practice Address - Phone:307-673-5177
Practice Address - Fax:307-673-5170
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8674385-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist