Individual
MR. JEREMY DAVID FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
12406 LA GRANGE RD STE 202, LOUISVILLE, KY 40245-1904
(502) 243-3733
(502) 243-3734
Mailing address
12406 LA GRANGE RD STE 202, LOUISVILLE, KY 40245-1904
(502) 243-3733
(502) 243-3734
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
18003525A
IN
152W00000X
Optometrist
Primary
1811DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11875636
CAQH
—
05
—
7100428530
—
KY
Enumeration date
06/27/2008
Last updated
09/27/2025
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