Provider Demographics
NPI:1285252262
Name:DOWDY, GEORGE JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:DOWDY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12422 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6392
Mailing Address - Country:US
Mailing Address - Phone:314-579-0909
Mailing Address - Fax:
Practice Address - Street 1:12422 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6392
Practice Address - Country:US
Practice Address - Phone:314-579-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020020105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist