Provider Demographics
NPI:1811980600
Name:COWAN, CLIFTON M (OD)
Entity type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:M
Last Name:COWAN
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:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71496-0681
Mailing Address - Country:US
Mailing Address - Phone:337-239-2020
Mailing Address - Fax:337-239-0755
Practice Address - Street 1:1100 N. 5TH ST.
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-3464
Practice Address - Country:US
Practice Address - Phone:337-239-2020
Practice Address - Fax:337-239-0755
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA953-128T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1342262Medicaid
LA0633160001Medicare NSC
LA1342262Medicaid