Provider Demographics
NPI:1366578882
Name:COWIE, EDMUND W (OD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:W
Last Name:COWIE
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 1:2 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1534
Mailing Address - Country:US
Mailing Address - Phone:518-877-8058
Mailing Address - Fax:
Practice Address - Street 1:2 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1534
Practice Address - Country:US
Practice Address - Phone:518-877-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002606-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT89545Medicare UPIN
NY0767240001Medicare NSC