Provider Demographics
NPI:1427066794
Name:ROWE, MICHAEL LEONARD (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEONARD
Last Name:ROWE
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 1:5000 LEONARDSBURG RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-9049
Mailing Address - Country:US
Mailing Address - Phone:740-774-4030
Mailing Address - Fax:740-774-1031
Practice Address - Street 1:85 RIVER TRCE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2686
Practice Address - Country:US
Practice Address - Phone:740-774-4030
Practice Address - Fax:740-774-1031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3438152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU39656Medicare UPIN
OHR00732602Medicare ID - Type Unspecified