Provider Demographics
NPI:1124131511
Name:FOWLER OPTICAL INC
Entity type:Organization
Organization Name:FOWLER OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SEC TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-793-2166
Mailing Address - Street 1:4224 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3013
Mailing Address - Country:US
Mailing Address - Phone:903-793-2166
Mailing Address - Fax:903-794-3222
Practice Address - Street 1:4224 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3013
Practice Address - Country:US
Practice Address - Phone:903-793-2166
Practice Address - Fax:903-794-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX506633OtherBLUE CROSS BLUE SHIELD
TX506633OtherBLUE CROSS BLUE SHIELD