Provider Demographics
NPI:1932197209
Name:TOWLE, STEVEN J (O D)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:TOWLE
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4112
Mailing Address - Country:US
Mailing Address - Phone:701-255-4673
Mailing Address - Fax:701-255-4934
Practice Address - Street 1:620 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4112
Practice Address - Country:US
Practice Address - Phone:701-255-4673
Practice Address - Fax:701-255-4934
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60432Medicaid
ND800506OtherBCBS VISION SERVICES
SD9202450Medicaid
SD9202450OtherSD MEDICAID
ND11138OtherBLUE CROSS BLUE SHIELD
NDU20370Medicare UPIN
ND11138OtherBLUE CROSS BLUE SHIELD