# DESTIN OPHTHALMOLOGY, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912994518
- **Authorized official:** DR. PRISCILLA G FOWLER MD (OWNER)
- **Authorized official phone:** (850) 622-0757

## Contact information

- **Practice address:** 7720 US HIGHWAY 98 W, SUITE 110, DESTIN, FL 32550-7230
- **Practice address phone:** (850) 622-0757
- **Practice address fax:** (850) 622-1978
- **Mailing address:** 7720 US HIGHWAY 98 W, SUITE 110, DESTIN, FL 32550-7230
- **Mailing address phone:** (850) 622-0757
- **Mailing address fax:** (850) 622-1978

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME90933 | FL | Yes |

## Other

- **Enumeration date:** 09/29/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | IND NPI | 1851398093 | — |