Basic Information
Provider Information
NPI: 1134399181
EntityType: 2
ReplacementNPI:  
OrganizationName: JODI L ROWSON AND ASSOCIATES INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 652 GREAT NORTHERN MALL
Address2:  
City: NORTH OLMSTED
State: OH
PostalCode: 440703306
CountryCode: US
TelephoneNumber: 4407345037
FaxNumber: 4407340527
Practice Location
Address1: 652 GREAT NORTHERN MALL
Address2:  
City: NORTH OLMSTED
State: OH
PostalCode: 440703306
CountryCode: US
TelephoneNumber: 4407345037
FaxNumber: 4407340527
Other Information
ProviderEnumerationDate: 03/05/2008
LastUpdateDate: 09/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ROWSON
AuthorizedOfficialFirstName: JODI
AuthorizedOfficialMiddleName: LYNN
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 4407345037
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: O.D.
NPICertificationDate: 09/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X  Y193400000X SINGLE SPECIALTY GROUPEye and Vision Services ProvidersOptometrist 

No ID Information.


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