Provider Demographics
NPI:1891548764
Name:POWLISON, ROBERT COLE (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:COLE
Last Name:POWLISON
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 1:3916 REFUGE RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-8718
Mailing Address - Country:US
Mailing Address - Phone:903-436-4085
Mailing Address - Fax:
Practice Address - Street 1:2515 W MORTON ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1403
Practice Address - Country:US
Practice Address - Phone:903-465-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11194T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist