Provider Demographics
NPI:1699777839
Name:FOWLER, PATRICK M (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:FOWLER
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 1:5560 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7338
Mailing Address - Country:US
Mailing Address - Phone:303-421-2424
Mailing Address - Fax:303-421-2155
Practice Address - Street 1:5560 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-7338
Practice Address - Country:US
Practice Address - Phone:303-421-2424
Practice Address - Fax:303-421-2155
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO410008892OtherPALMETTO GBA - RAILROAD MEDICARE
CO08007536Medicaid
CO0241210001Medicare NSC
CO08007536Medicaid
COCA2333Medicare PIN