Provider Demographics
NPI:1154366102
Name:SOWELL, STEVEN (O D P A)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SOWELL
Suffix:
Gender:M
Credentials:O D P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-3349
Mailing Address - Country:US
Mailing Address - Phone:870-863-0856
Mailing Address - Fax:870-862-9123
Practice Address - Street 1:2033 N WEST AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-3349
Practice Address - Country:US
Practice Address - Phone:870-863-0856
Practice Address - Fax:870-862-9123
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2252152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101756722Medicaid
AR410046934OtherPALMETTO GOVT RAILROAD
AR410046934OtherPALMETTO GOVT RAILROAD
AR49027Medicare ID - Type Unspecified
AR0164890001Medicare NSC