Basic Information
Provider Information | |||||||||
NPI: | 1275980633 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TOM SOWASH OD & ASSOCIATES, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | VISIONWORKS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 849764 | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752847964 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2105246771 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 21227 S ELLSWORTH LOOP RD | ||||||||
Address2: | STE 102 | ||||||||
City: | QUEEN CREEK | ||||||||
State: | AZ | ||||||||
PostalCode: | 851429868 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4809873097 | ||||||||
FaxNumber: | 4809878380 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/16/2016 | ||||||||
LastUpdateDate: | 07/12/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | REYNOLDS | ||||||||
AuthorizedOfficialFirstName: | DOROTHY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VP, MANAGED CARE | ||||||||
AuthorizedOfficialTelephone: | 2105246515 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |   |
No ID Information.